Nancy suchman - US grants

DESCRIPTION: (Provided by Applicant) During the past two decades, although much has been learned about risk factors associated with maternal addiction and parenting, little research has focused on the internal conceptions of drug-addicted mothers in the parenting role, and how these conceptions function as mediators in the parenting process. The goal of this mentored patient-oriented research career award is to allow the candidate to develop a research career in the area of maternal addiction and parental development. Dr. Suchman is currently the Project Director for the NIDA funded grant, "Relational Parenting Therapy for Opiate-Addicted Mothers" (R0l-DA11498) and has been examining the role of psychosocial risk in the parenting problems of opiate-addicted mothers. In the next several years, Dr. Suchman plans to conduct longitudinal research examining the role of internal conceptions of parenting in the parenting processes of cocaine and opiate-addicted mothers and its implications for parenting intervention development. Specifically, her research plan includes a 4-year longitudinal study of cocaine-addicted mothers and infants to ascertain mothers? internal representations of parenting and associations between internal representations and other parenting dimensions (e.g., psychosocial risk, parenting behaviors, child development). She will also examine cross-sectional data from opiate-addicted mothers of older children to ascertain associations between internal representations and parenting dimensions. Her proposed research will enable her to develop skills in the following areas: 1) qualitative assessment of internal working models of parenting, 2) assessment of parent-child interactions, 3) infant and child assessment, 4) longitudinal research design and data analytic strategies, 5) psychotherapy research, and 6) applications of developmental psychopathology to parental development. Dr. Suchman?s training combines formal course work with clinical research experience at several sites affiliated with the Yale School of Medicine and the Yale Child Study Center. She will work closely with Drs. Bruce Rounsaville, Linda Mayes, and Suniya Luthar to receive training in the above areas. In this way, Dr. Suchman will be well prepared to achieve her long-term career goal of conducting longitudinal research on the etiology of maladaptive parenting among drug-addicted mothers and applying her findings to the development of parenting interventions.

DESCRIPTION (provided by applicant): Five years ago we were funded to develop the Mothers and Toddlers Program or MTP (R01 DA17294 / Project Period: 8/20/04 - 12/31/09). MTP is the first parenting intervention developed for substance abusing mothers that is based on the principles of attachment theory. It is also the only parenting intervention for substance abusing mothers that has led to improvement in maternal caregiving sensitivity and responsiveness to infant and toddler distress in observed lab-based interactions. We now have all the research materials we need to conduct a Stage II randomized clinical trial. Materials include: the MTP treatment manual, instructions for conducting PEP - the comparison intervention, treatment fidelity scales and manual, MTP therapist training program, outcome assessments and measures. We have also completed a randomized clinical trial - a preliminary test of the efficacy of MTP in comparison with the Parent Education Program (PEP), an individual supportive comparison intervention. Outcome data from the intention-to-treat sample of 47 randomized subjects shows that MTP led to greater improvement than PEP in all targeted parenting outcomes (capacity for reflective functioning, quality of maternal representations and caregiving behavior) and global psychiatric distress. Having met the objectives of the Stage I investigation and having evidence of MTP's feasibility and promise, we now seek to conduct a formal definitive efficacy test of MTP in a full-scale Stage II randomized trial. In the Stage II investigation, we will: (1) Introduce new measures of dyadic adjustment and child attachment, (2) Add an 18 week follow up period to test for sustained treatment effects, (3) Measure major constructs (reflective functioning, representations, dyadic adjustment, and child attachment) when they are expected to change, (4) Examine temporal mechanisms of change proposed in the MTP treatment model (5) Determine whether improvements in dyadic adjustment reduces incidence of relapse, (6) Broaden the MTP therapist pool by training four new therapists and (7) Broaden the coding pool by training 3 additional coders per measure. One hundred and fifty mothers caring for children ages 12 to 24 months of age will be recruited from outpatient substance abuse treatment services at the APT Foundation into the intention-to-treat sample and will be randomized to 12 weeks of MTP vs. PEP and followed for 33 weeks. . PUBLIC HEALTH RELEVANCE: As a group, mothers with substance abuse disorders are at high risk for maladaptive parenting practices that have lasting implications for children and families --- and society, which bears much of the cost for future educational and medical services. This project aims to evaluate a parenting intervention that has shown promise for improving the parenting practices and mental health among women seeking treatment for their substance use disorders. The evaluation and dissemination of effective parenting interventions for this population has the potential to prevent the transmission of psychological and medical problems to future generations.

DESCRIPTION (provided by applicant): This K02 application seeks support for a research psychologist to conduct a program of research that (a) translates attachment principles into clinical parenting interventions for substance abusing mothers who are caring for infants and toddlers and (b) tests hypothesized cyclical mechanisms linking maternal exposure to typical parenting stressors, maternal affect dysregulation and risk for relapse to drug use, maternal insensitivity to child emotional cues and child emotional dysregulation. This work has vital implications for the prevention of substance abuse and maladaptive parenting in families affected by maternal substance abuse. Funded by a K23 award for 5 years, the candidate has translated a sophisticated understanding of attachment mechanisms into an innovative approach to treating parenting disorders in substance abusing women. She received funding from NIDA (R01DA17294) to further develop and evaluate this intervention. She has also applied attachment principles to empirical investigation of the relational problems of substance abusing mothers and their children. She now seeks to (1) analyze and interpret her intervention outcomes, (2) design appropriate follow up studies using the NIDA stage model, (3) identify salient therapeutic mechanisms in her intervention approach, (4) examine whether typical parenting stressors increase maternal risk for relapse (5) examine links between maternal substance abuse and delayed recognition of child emotional cues, and (6) examine whether abstinence from drug use can improve tolerance for parenting stress. The candidate will further develop her skills to (a) interpret Stage I findings, (b) design appropriate follow-up intervention research, (c) design studies to statistically analyze therapeutic mechanisms of change, (d) develop research paradigms for measuring maternal response to parenting stressors and (e) develop procedures for measuring maternal thresholds for detecting child emotional cues. During the period of support, her research will include two major efforts: (1) the analysis of process and outcome data from 60 mothers completing a randomized pilot study testing the preliminary efficacy of her attachment-based intervention, and (2) completion of a preliminary study with 40 mothers in which newly-developed parenting stress paradigms will be used to test proposed links between parenting stressors, risk for relapse, caregiving insensitivity and child emotional dysregulation.

DESCRIPTION (provided by applicant): Five years ago we were funded to develop the Mothers and Toddlers Program or MTP (R01 DA17294 / Project Period: 8/20/04 - 12/31/09). MTP is the first parenting intervention developed for substance abusing mothers that is based on the principles of attachment theory. It is also the only parenting intervention for substance abusing mothers that has led to improvement in maternal caregiving sensitivity and responsiveness to infant and toddler distress in observed lab-based interactions. We now have all the research materials we need to conduct a Stage II randomized clinical trial. Materials include: the MTP treatment manual, instructions for conducting PEP - the comparison intervention, treatment fidelity scales and manual, MTP therapist training program, outcome assessments and measures. We have also completed a randomized clinical trial - a preliminary test of the efficacy of MTP in comparison with the Parent Education Program (PEP), an individual supportive comparison intervention. Outcome data from the intention-to-treat sample of 47 randomized subjects shows that MTP led to greater improvement than PEP in all targeted parenting outcomes (capacity for reflective functioning, quality of maternal representations and caregiving behavior) and global psychiatric distress. Having met the objectives of the Stage I investigation and having evidence of MTP's feasibility and promise, we now seek to conduct a formal definitive efficacy test of MTP in a full-scale Stage II randomized trial. In the Stage II investigation, we will: (1) Introduce new measures of dyadic adjustment and child attachment, (2) Add an 18 week follow up period to test for sustained treatment effects, (3) Measure major constructs (reflective functioning, representations, dyadic adjustment, and child attachment) when they are expected to change, (4) Examine temporal mechanisms of change proposed in the MTP treatment model (5) Determine whether improvements in dyadic adjustment reduces incidence of relapse, (6) Broaden the MTP therapist pool by training four new therapists and (7) Broaden the coding pool by training 3 additional coders per measure. One hundred and fifty mothers caring for children ages 12 to 24 months of age will be recruited from outpatient substance abuse treatment services at the APT Foundation into the intention-to-treat sample and will be randomized to 12 weeks of MTP vs. PEP and followed for 33 weeks. .

? DESCRIPTION (provided by applicant): This is an application to fund a new Stage III community-based randomized clinical efficacy trial testing Mothering from the Inside Out (MIO), the first evidence-based parenting intervention designed to be delivered by addiction counselors in addiction treatment settings where parents of young children are enrolled in treatment. In two (Stage I and II) randomized clinical efficacy trials conducted during the first 9 years of this award, when compared with a standard parent education program (PE), MIO demonstrated efficacy for improving parenting, child attachment security and for positively impacting abstinence from drug use. Importantly, mothers with high addiction severity assigned to MIO showed notable improvement across all outcomes. MIO is a weekly individual parenting therapy developed as an enhancement to standard addiction treatment that targets the addicted mother's capacity to recognize and regulate her own emotional distress during stressful parenting situations so that she can support her child's developing capacity for emotional and behavioral regulation. This capacity, called reflective functioning (RF), is a psychological skill that promotes abstinence and also helps parents foster their young children's secure attachment. Now that MIO has demonstrated efficacy in two randomized efficacy trials, the next step will be to conduct a new Stage III community-based efficacy trial where addiction counselors are trained to deliver MIO and PE with fidelity in an addiction treatment setting and to evaluate treatment outcomes and mechanisms of change in this community setting. This will be one of the first investigations implementing a new stage model for intervention research (Onken et al., 2014) where efficacious interventions are first tested under conditions of high internal validity (with treatment fidelity assured) before effectiveness is tested under conditions of high external validity. At the end of this trial, if MIO demonstrates efficacy, we will have allthe necessary materials to train addiction counselors across a broad range of treatment settings in a Stage IV effectiveness trial. In the first year, we will conduct a training pilot where 14 addicton counselors in an addiction treatment clinic will be randomly assigned to training in MIO vs PE delivery and complete a training case with a real patient during which fidelity will be measured. In years 2 - 5, 160 mothers in addiction treatment and caring for children ages 12 - 24 months will be randomized to 12 sessions of MIO vs PE with a trained addiction counselor and fidelity will be monitored and maintained for treatment duration. We predict that 1. When delivered by trained addiction counselors, MIO and PE can be discriminated; 2. MIO-assigned mothers will demonstrate greater improvement in reflective functioning and abstinence from substance use and their children will show greater improvement in attachment security at post-treatment and follow up; 3. MIO will confer greater advantage than PE for mothers with high addiction severity; and 4. Higher treatment fidelity will mediate better treatment outcomes and improvements in RF will mediate improvement in abstinence and child attachment security.