Maintaining participation and momentum in longitudinal research involving high-risk families.

PURPOSE: The purpose of the current study was to identify and describe strategies available to optimize retention of a high-risk research cohort and assist in the recovery of study participants following participant dropout. DESIGN AND METHODS: The Maternal Lifestyle Study (MLS), which investigated the effects of prenatal substance exposure (cocaine or opiates) on child outcome, is a prospective longitudinal follow-up study that extended from birth through 15 years of age. Retention strategies to maximize participation and factors that might negatively impact compliance were examined over the course of five follow-up phases. FINDINGS: At the conclusion of the 15-year visits, MLS had successfully maintained compliance at 76%. Retention rates did not differ by exposure group. CONCLUSIONS: Maintaining ongoing participation of enrolled study subjects is a critical element of any successful longitudinal study. Strategies that can be used to reengage and maintain participants in longitudinal research include persistence, flexibility with scheduling, home visits, long-distance trips, increased incentives, and development of a computerized tracking system. Establishing rapport with families and ensuring confidentiality contributed to overall participant retention. The use of multiple tracking techniques is essential. CLINICAL RELEVANCE: Researchers are challenged to maintain participants in longitudinal studies to ensure the integrity of their research.

A randomized control trial of integrated care for families managing infant colic.

This article presents a randomized clinical trial examining the effectiveness of a unique model of integrated care for the treatment of infant colic. Families seeking help for infant colic were randomized to either the family-centered treatment (TX; n = 31) or standard pediatric care (SC; n = 31). All parents completed 3 days of Infant Behavior Diaries (Barr et al., 1998) and the Colic Symptom Checklist (Lester, 1997), Beck Depression Inventory (Beck & Steer, 1984), and Parenting Stress Index 3rd ed.-SF (Abidin, 1995). TX families were seen three times by a pediatrician and a mental health clinician within 1, 2, and 6 weeks of baseline data. TX families received individualized treatment plans addressing problem areas of sleep, feeding, routine, and family mental health. SC families were seen only by their own healthcare provider. All families were visited at home by a research assistant to retrieve data at 2, 6, and 10 weeks after baseline. Family-based treatment accelerated the rate of reduction of infant crying faster than did standard pediatric care. Infants in the TX group had more hours of sleep at 2 weeks posttreatment and spent less time feeding at 2, 6, and 10 weeks posttreatment than did SC infants. Results indicate that individualized family-based treatment reduces infant colic more rapidly than does standard pediatric care.

Colic: What's maternal mental health got to do with it?

Families can benefit when pediatric and mental health professionals have a greater appreciation of psychological and relational issues that arise in the course of caring for an infant with colic. The Infant Behavior, Cry, and Sleep Clinic is a multidisciplinary, clinical intervention for parents who identify infant crying as adversely affecting infant, parental, and/or family functioning. Pairing pediatric and mental health expertise provides parents with strategies to manage infant colic within a context that recognizes parental mental health needs. Clinical case material illustrates varying responses and degrees of psychological distress in mothers whose infants have colic. Treatment approaches to colic that take into account maternal mental health needs may contribute to more optimal infant, maternal, and family outcomes.

A care coordination program for substance-exposed newborns.

The Vulnerable Infants Program of Rhode Island (VIP-RI) was established as a care coordination program to promote permanency for substance-exposed newborns in the child welfare system. Goals of VIP-RI were to optimize parents' opportunities for reunification and increase the efficacy of social service systems involved with families affected by perinatal substance use. Findings from VIP-RI's final four years show that by 12 months, 86% of substance-exposed newborns had identified permanent placements and 77% were placed with biological parents or relatives.

Vulnerable infants program of Rhode Island: promoting permanency for substance-exposed infants.

The Vulnerable Infants Program of Rhode Island is a care coordination program to promote permanency for substance-exposed infants by addressing parental needs and increasing collaboration among social service agencies. Over the first four years of the program, there was a decrease in time spent in the newborn nursery beyond medical necessity and identification of permanent placements by 12 months for 84% of infants, with the majority of infants (78%) placed with biological parents or relatives.

Services used by perinatal substance-users with child welfare involvement: a descriptive study.

BACKGROUND: Substance use during pregnancy often leads to involvement in the child welfare system, resulting in multiple social service systems and service providers working with families to achieve successful child welfare outcomes. The Vulnerable Infants Program of Rhode Island (VIP-RI) is a care coordination program developed to work with perinatal substance-users to optimize opportunities for reunification and promote permanency for substance-exposed infants. This paper describes services used by VIP-RI participants and child welfare outcomes. METHODS: Data collected during the first four years of VIP-RI were used to identify characteristics of program participants, services received, and child welfare outcomes: closed child welfare cases, reunification with biological mothers and identified infant permanent placements. DESCRIPTIVE RESULTS: Medical and financial services were associated with positive child welfare outcomes. Medical services included family planning, pre- and post-natal care and HIV test counseling. Financial services included assistance with obtaining entitlement benefits and receiving tangible support such as food and clothing. CONCLUSIONS: Findings from this study suggest services that address basic family needs were related to positive child welfare outcomes. The provision of basic services, such as health care and financial assistance through entitlement benefits and tangible donations, may help to establish a foundation so mothers can concentrate on recovery and parenting skills. Identification of services for perinatal substance users that are associated with more successful child welfare outcomes has implications for the child welfare system, treatment providers, courts and families.

After family treatment drug court: maternal, infant, and permanency outcomes.

This study reports on maternal functioning, infant developmental, and permanency outcomes for 52 families following maternal participation in a family treatment drug court (FTDC) for perinatal substance users. Although the majority of families experienced positive child welfare outcomes, over time, maternal functioning deteriorated and infant developmental concerns were identified. Even when promising interventions like FTDC are used, long-term needs of families affected by perinatal substance use need to be considered and addressed.

Treatment of substance abuse during pregnancy.

Treatment programs for women who use drugs during pregnancy have developed out of a backdrop of punitive policies and the psychosocial complexities of this population, which include psychological comorbidities and consideration of the needs of their children. In this literature review, we examine evidence-based approaches to treatment for these women and some promising newer initiatives. We also discuss limitations of this research and issues that need to be addressed. The increasing understanding and acceptance of substance abuse as a treatable mental health disorder brings renewed optimism to this field.

Partners of perinatal substance users: forgotten, failing, or fit to father?

The role fathers play in families affected by perinatal substance use largely has been unexamined. It is difficult to reconcile this peripheral role assigned to the fathers of substance-exposed infants as the importance of fathers in the lives of children and of partners in the lives of substance-using women has become better appreciated. In this article, case presentations of families in which both parents were substance users illustrate the complexities and diverse trajectories of relationships between perinatal substance users and their children's fathers. An examination of families' lives can be used to better understand the challenges they face, stimulate further discussion about how partners of perinatal substance users can be conceptualized as fathers, and consider the impact they have in the lives of their children and their children's mothers. Discussion of case studies can yield increased knowledge about the role of fathers in the lives of families affected by perinatal substance abuse. This will lead to better-informed treatment interventions, research, and public policy.

Permanency planning and social service systems: A comparison of two families with prenatally substance exposed infants.

An innovative program developed to work with families in which substance use during pregnancy leads to Child Protective Services involvement is introduced in this article. The Vulnerable Infants Program of Rhode Island (VIP-RI) was established to facilitate permanency planning for substance-exposed infants by focusing on the interface of social service systems with one another and with the families affected by perinatal substance use. Permanent placement within the time frame mandated by federal legislation places increased pressures on parents and the social service systems designed to provide them with assistance. The Vulnerable Infants Program of Rhode Island promotes collaboration, coordination, and communication among social service systems engaged with families of substance-exposed infants. The Vulnerable Infants Program of Rhode Island works to increase the efficacy of social service systems in order to optimize the resources that are available to a family in their attempts at reunification with their infant. Case examples illustrate the complexities of the families of substance-exposed infants, the breadth of social service systems that become involved with these families, and the vastly different placement outcomes that substance-exposed infants may experience.