Education Program Significantly Benefits Adolescents Exposed to Parental Opioid Use

Brand Mechling, PhD, RN, PMHCNS-BC (UNCW)

A recent study found that children who have a parent with opioid use disorder (OUD) experienced an increase in metric-based knowledge and resilience following intervention programs.

Investigators, led by Brandy M. Mechling, PhD, RN, PMHCNS-BC of the School of Nursing, College of Health and Human Services, at the University of North Carolina Wilmington, administered the Substance Abuse and Mental Health Administration’s Children’s Program Kit (CPK): Supportive Education for Children of Addicted Parents (SAMHSA) to children participating in the study.

Over 2 million individuals in the United States have opioid use disorder (OUD). The National Survey on Drugs and Health 2009 – 2014 find that 1 in 8 children reside in a home where 1 or both parents have a substance use disorder (SUD).

Investigators say children living with a parent with OUD may be exposed to opioid use and experience multigenerational substance abuse when removed from parent’s care. Data show children tend to remain in foster care longer as well.

Outcomes for children exposed to substance abuse include developing mental illness, SUD or alcoholism. Children with parents with OUD have higher rates of externalizing disorders (ADHD), internalizing disorders (depression, anxiety), and SUDS, as well has physical health impacts because of negligent care.

Investigators found a lack of programs focus on children growing up with a parent with OUD.

Thus, the team implemented the CPK SAMHSA program to build strength and resilience in children with a parent with a substance disorder.

The Study

Investigators sought 4 overall objectives for children, including:

• Knowing they are not alone and not responsible for the parent's addiction
• Learning problem‐solving skills, especially geared to safety
• Focusing on strengths to overcome ACEs and foster resilience
• Helping children understand and express emotions regarding the parent's addiction, encouraging sharing with parents so they can better understand the child's perspective

The team worked with an agency of the Department of Social Services (DSS) in southeastern North Carolina.

Study participants were required to have a parent addicted to opioids for at least the last year of when the participant lived with the parent. The participant must be in DSS custody or residing in foster care and must be between 12 – 17 years old.

Investigators served as interventionists in the study, with an eight-week intervention. There were 6 intervention sessions, in between an introductory and wrap-up session.

The participants and foster parent had to complete a demographic form at the first visit. The foster parent completed versions of the Behavioral and Emotional Rating Scale (BERS-2) at preintervention and postintervention.

The BERS-2 test identified the participant’s strengths and resources in coping with stress and forming positive relationships on a 57-question strength index.

The test included scales on interpersonal strength, family involvement, intrapersonal strength, and affective strength, while career strength was also included to determine the child’s interest and aptitude for a career.

Each statement in the test is measured on a 0 – 3 scale. The team converted each score to provide a scaled score and created a total strength index score.

3 = statement is very much like the participant

2 = the statement is like the participant

1 = the statement is not very much like the participant

0 = the statement is not at all like the participant.

Participants also completed a knowledge test of OUD, which included 15 yes or no questions. Correct answers were given a point and added at the end for a final score.

The team used paired‐samples t tests to compare youth OUD knowledge and youth and parent BERS scores.

Results

The results included 9 patients, with 5 females and 4 males, with a mean age of 14.5 years old, who had a parent with an OUD and now reside in DSS custody. The patient’s parents who had OUD included the mother (n = 5) or both parents (n = 4).

The paired-sample t test showed a significant difference in youth OUD knowledge preintervention (mean, 11.55) to postintervention (mean, 14.33; t (8), 2.65; P <.05). The mean increase in the pre- to-post intervention score was 3 points.

A significant increase on the strength index for the youth BERS-2 from pre-intervention (mean, 103.44) to post intervention (mean, 112.55; t (8), 2.43; P <.05). There was a mean increase of 9 points.

Another strength index included youth career strength, which found further significant differences from pre-intervention (mean, 7.33) to post-intervention (mean, 10.33; t (8), 3.23; P <.05).

Conclusion

Investigators concluded that the results of the study supported the development and implementations of interventions, including the CPK.

They said it is essential for Psychiatric Mental Health (PMH) nurse researchers to use interventions such as the CPK for children with an SUD.

“PMH nurses are cognizant of the importance of enhancing resilience in this population and can be leaders in the planning and implementing of specific interventions or programs,” investigators wrote. “Often when the parent is in treatment for OUD, the children's needs are not addressed.”

Investigators said the earlier the child receives intervention, the more promising the outcome, but the lack of complete programs may not be able to deliver the positive effects of childhood intervention.

“Rather than developing new programs, existing interventions may be able to be modified for current use,” investigators said. “Building evidence‐based interventions focused on the child and that are substance specific could be a missing link in combating these multigenerational cycles.”

The study, “Promoting resilience for children of parents with opioid use disorder: A pilot study of a directed intervention,” was published online in the Journal of Child and Adolescent Psychiatric Nursing.