Intergenerational Trauma Prevalence in Substance Use DisorderWill Giebert, MPA

Kiley Compton, MA

Overview

Evidence-Based Practicesand Interventions

Family Baselines Family OutcomesHelen Ross McNabb Center (HRMC) offers New Beginnings for Families, a substance use disorder (SUD) treatment program for families funded through the Department of Health and Human Services, Children’s Bureau, Regional Partnership Grant. Families are provided SUD treatment through either in-home, intensive outpatient, or residential-based modalities. Demographic, health, and family history data along with psychometric assessments are collected and traced at structured intervals during families’ treatment and at 3-, 6-, 12-, and 18-months post-discharge from treatment services. A rigorous evaluation conducted by internal evaluators at HRMC utilize these data to assess and compare processes and outcomes across the separate modalities.

Intergenerational TraumaPrevalence

Contributing Factors

References

Many participants have extensive acute and complex trauma histories including cyclical and inter-generational abuse. The average Adverse Childhood Experience (ACE) score among participants in the residential-based program is 5.6. Participants are at high risk of continuing the cycle of intergenerational violence, abuse and trauma with their children who face substance exposure, NAS, parental incarceration and foster care.

37.5% of clients scored in the elevated risk range of the Trauma Symptoms Checklist (12 of 32) at baseline.

New Beginnings for Families implements family-focused and trauma-informed EBPs to address co-occurring substance use disorder and trauma and improve family functioning, stability, and cohesion. Celebrating Families! (CF!) combines SUD recovery concepts with healthy family living skills in a cognitive behavioral support group model for families that present with parental substance use disorder and high risk for child abuse or neglect.Family Behavior Therapy (FBT) addresses SUD along with family/social relationships, employment and education through a Community Reinforcement Approach.Hazelden Co-occurring Disorders Program (CDP) addresses and treats co-occurring substance use and non-severe mental health disorders through combined, integrated therapies.Nurturing Parenting reinforces positive parenting behaviors through a family-centered, trauma-informed approach focusing on reducing intergenerational child abuse and substance use. Seeking Safety addresses co-occurring substance use and trauma through a highly flexible, present-focused therapy model aimed at increasing safety and safe coping skills.

Definitions:“Family” refers to the family unit consisting of the adult(s) receiving SUD treatment.

“Target Child” refers to the youngest child of the adult(s) receiving SUD treatment.

Contributors: Erika Panek, MSSW; Sarah Long, LCSWData was collected from clients served through New Beginnings for Families in-home and residential-based modalities from January 1, 2014 – June 30, 2016.

Emotional Abuse as an adult

Sexual Abuse/rape as an adult

Domestic Violence as an adult

Sexual Abuse as a child

Physical Abuse as a child

0 50 100 150 200 250 300

187

144

135

84

64

63

104

120

171

190

Trauma history

Yes No

Other family member(s)

Step-parent(s)

Sibling(s)

Father

Mother

0 50 100 150 200 250 300

52

54

130

154

123

101

102

108

92

130

Family history of substance abuse

Yes No

At discharge, participating families reported the following outcomes:

Housing • 83.1% (206 of 248) were living in sober housing

(free of substance use).• 89.6% (138 of 154) were living in safe housing

(free of violence or other danger).• 86.3% (132 of 153) were living in stable

housing (no threat of eviction).

Permanency• 67.4% of Target Children (153 of 227) resided

at home with their family (with or without open child welfare cases).

• 61.8% of Target Children (123 of 199) resided in their family’s physical custody.

• 50.8% of families that did not have custody of their Target Child at the beginning of treatment either began or increased visitation with their Target Child (34 of 67).

• 18.7% of families that did not have custody of their Target Child at the beginning of treatment were reunified with their Target Child (12 of 65).

Well-being• 75% (24 of 32) improved or scored the same

level on the Trauma Symptoms Checklist.• 90.5% (19 of 21) improved or scored the same

level on the CES-D depression scale.• 100% (6 of 6) improved on the Parental Stress

Index measure.

“I want people to know. We have no control over our disease; it controls us. Until you’re ready to give up the control, you’ll never get better.” – New Beginnings for Families client

“I wanted a different life for my daughter. I have two other kids that have had it rough and want things to be different for her. This program saved my life and my relationship with my daughter.” – New Beginnings for Families client

1. Family Development Resources. Nurturing Parenting. 2. Hazelden Betty Ford Foundation. Hazelden's Co-occurring Disorders Program (CDP).3. JBS International, Inc. and The Center for Children and Family Futures. (2007). Family-

Centered Treatment for Women with Substance Use Disorders: History, Key Elements, and Challenges. Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment.

4. Najavits, L. M. (2002). Seeking Safety: A Treatment Manual for PTSD and Substance Abuse. New York: The Guilford Press.

5. Substance Abuse and Mental Health Services Administration. Family Behavior Therapy. SAMHSA's National Registry of Evidence-based Programs and Practices.

6. The National Abandoned Infants Assistance Resource Center. (2005).Celebrating Families: An Innovative Approach for Working with Substance Abusing Families. The Source, 6-10.

Acute and Chronic Abuse,

Assault, Maltreatment, Neglect, and Separation

Persistent Symptoms of Trauma and

Substance Use Disorder

Family History of Substance Use

Disorder

“I keep remembering how good it felt to be clean… for my family to trust me…to have a job …to buy whatever I wanted. I want my kids to have things that I didn’t have growing up. I have a sixteen year old daughter and she watches and sees what I do and I don’t want her doing the things I did. I just want to live life again and be happy.” – New Beginnings for Families client

Opiates form the majority of both the primary substance problem requiring treatment (56.4%) and the drug of choice (60.2%) of 257 clients surveyed.

Incarceration Mental health disorder

Child welfare removal

Parental criminal involvement

Parental mental health disorder

0%

10%

20%

30%

40%

50%

60%

70%

80%71%

47%39% 41%

48%

FAMILY RISK FACTORS