This SOAR proposal is submitted to expand and strengthen a study that is currently underway with John A. Hartford Foundation funding awarded to the principal investigator, who meets the NIH early stage investigator criteria. This research addresses the alarming increase in the rate of incarceration among women in the United States, its intersection with substance abuse, and its disproportionate impact upon African American and Latina women. The majority of women who are incarcerated resided with their minor children prior to their incarceration and more than half of their children are cared for by a grandparent, disproportionately a grandmother, during their incarceration. A growing body of research suggests that family treatments yield improved treatment engagement and retention, reduced substance use, and improved individual and family functioning in comparison to individual treatment or waitlist conditions for adults with alcohol and substance use disorders. Research has also begun to demonstrate that interventions with incarcerated mothers and their children yield positive psychosocial outcomes, including reduced re-incarceration, but only one known intervention study has included caregiving grandmothers, despite their key familial roles and the potential for their involvement to enhance treatment retention and gains for incarcerated mothers with substance use disorders. This stage Ia/Ib therapy development study draws upon a multigenerational stress-process theoretical framework and principles of community-based participatory research to pursue the following aims: 1)conduct separate focus groups with incarcerated mothers with substance use disorders and grandmothers who are caring for their daughters'children during their incarceration to identify the psychosocial strengths, needs, and service preferences of the mothers, grandmothers and children;2)draw upon gathered focus group data and family systems, cognitive and behavioral theories to design and pilot-test an innovative, culturally- relevant family therapy model;3)recruit 30 incarcerated women who are participating in drug court-referred residential treatment in a county jail to be randomly assigned to treatment as usual (n=15) or to treatment as usual plus the novel family therapy component (n=15) and recruit the mothers of the women participating in the novel family therapy arm to participate in the family therapy component (n=15);4)conduct baseline and post- treatment measurement of family relationships, coping, substance use, incarceration status and HIV risk behaviors among mothers;family relationships, coping, substance use, and psychosocial strain among grandmothers;and behavioral functioning among children;and 5)evaluate the acceptability of the novel family treatment component to the participants. In light of the significant potential for family treatment to reduce mothers'substance use, re-incarceration, and involvement in HIV drug and sexual risk behaviors;to reduce caregiving grandmothers'psychosocial strain and substance use risk, and to strengthen children's behavioral functioning, this study addresses a critical gap in both science and evidence-based practice in this area.
In light of the high prevalence of substance use disorders among women who are incarcerated, the multigenerational effects of maternal incarceration and substance abuse, and the limited family treatment research in this area, this study addresses a critically important gap in science and practice. This study's development of a novel family treatment for incarcerated mothers with substance use disorders and their mothers who are caring for their children during their incarceration holds potential to positively affect several serious public health concerns, including substance abuse, re-incarceration, and HIV drug and sexual risk behaviors among the mothers;biopsychosocial strain and substance use risk among the grandmothers;and behavioral functioning among the children.
