Psychosocial, pharmacological, and legal interventions have variable effects on the psychosocial outcomes of children whose parents misuse substances
Ninety-nine studies examined the effects of psychosocial, legal, and pharmacological interventions compared with treatment-as-usual (TAU) or other treatments for children in families affected by parental substance misuse. The quality of the evidence varies, and the effectiveness of interventions differs across outcomes and timing of measurement after intervention completion.
What is this review about?
Parental substance misuse is a pervasive risk factor for a range of detrimental outcomes for children across the life course. A range of interventions have been developed for this population, but the existing evidence-base requires consolidation to facilitate evidence-informed decisions between different intervention approaches.
This review synthesises the full array of psychosocial, pharmacological, and/or legal interventions for families affected by parental substance misuse, including interventions that integrate psychosocial, pharmacological, legal intervention approaches. The effectiveness of these interventions is assessed using a broad range of child psychosocial outcomes, including engagement with child protection agencies, development, psychological and behavioural wellbeing, and educational engagement and achievement.
What is the aim of this review?
This review aimed to consolidate and synthesise the effectiveness of psychosocial, pharmacological, and legal interventions on the psychosocial outcomes of children with substance misusing parents. The review synthesises evidence from 46 randomised controlled trials (RCTs) and 53 high-quality quasi-experiments.
What studies are included?
This review includes 99 studies, mostly conducted in the United States, spanning the period from 1984 to 2021. Included studies compare a psychosocial, pharmacological and/or legal intervention to TAU, an alternative treatment, or no treatment. All included studies examine the impact of the intervention upon completion, and a smaller number also examine effectiveness at later time-points (e.g., 6-months or more).
What are the main findings of this review?
The most robust findings from this review are drawn from 36 meta-analyses. These suggest that integrated interventions can reduce child abuse potential, the likelihood of out-of-home care (OOHC), and overall child emotional and behavioural difficulties in the short-term (small to medium sized effects). Integrated interventions typically combine psychosocial support for multiple areas of family wellbeing (e.g., parent substance misuse, parenting, child and parent psychological wellbeing), sometimes with pharmacological (e.g., opioid replacement therapy), legal components (e.g., Family Treatment Drug Courts [FTDCs]) and comprehensive case-management. These interventions can also increase the odds of parents retaining care of their children, enhance expressive language development, increase children’s knowledge of substance misuse, and increase child prosocial behaviours in the short-term (small to medium sized effects). There is preliminary evidence that effects are maintained within 6 to 12 months post-intervention for total child emotional and behavioural difficulties (small sized effect). However, the evidence for effectiveness for other outcomes was less clear. At treatment completion, this includes: children’s permanent placements (with parents, via adoption, or via long-term foster care/guardianship), some child development outcomes (cognition, receptive language, motor, and social skills), and some emotional/behavioural issues at posttreatment (e.g., externalising issues, internalising issues, level of anger, anxiety symptoms, depressive symptoms, self-concept, and locus of control). At follow-up from 3 to 18-months, evidence for effectiveness was less clear for child abuse potential, externalising issues, internalising issues, prosocial behaviours, and antisocial behaviours.
What is the quality of the evidence?
The quality of the evidence for psychosocial, pharmacological and/or legal interventions for children with substance misusing parents varies. This variation, along with large amounts of missing data, reduces the confidence that can be placed in the findings for many outcome categories.
What do the findings of this review mean?
The evidence for psychosocial, pharmacological, and/or legal interventions for families affected by parental substance misuse has not yet reached a point where clear conclusions can be made about the effectiveness of the full range of interventions across the full range of child psychosocial outcomes. However, there is reliable evidence for interventions that integrate parent substance misuse treatment with other components that simultaneously aim to alleviate vulnerability in other areas of the family ecology. The amount and quality of the evidence needs to continue growing so that policy makers and practitioners can make evidence-based decisions that are most likely to improve the lives of families affected by parental substance misuse.
How up-to-date is this review?
The review authors searched for studies that were reported through to April 2021.