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Treatment of maternal substance-related problems is often complicated by complex pictures of risk, including mental and physical illness and social-contextual risk. In motherhood, systemic barriers, such as lack of childcare and stigma, further complicate access and sustained treatment engagement. Integrated programs are designed to address this issue by providing treatment for substance use, as well as services to address other maternal, parenting, and child needs, ideally at a single access point. Despite growth in integrated programs, a common theoretical framework to inform service provision is lacking. This has resulted in considerable heterogeneity among integrated programs and hindered multi-site evaluation. This study sought to develop a theoretical model of integrated treatment, with a focus on the therapeutic relationship and how the relationship serves to support two common areas of need in this population: emotion regulation (ER) and executive functions (EF). As part of a multi-site evaluation of integrated substance use treatment, six client focus groups (N = 50) were conducted to explore client perspectives on integrated treatment and specifically aspects of the therapeutic relationship they found most/least helpful. Thematic analysis revealed approaches and behaviors of counselors that support ER and EF. These themes are presented and contextualized within the literature that addresses ER and EF risk from a mental health and socio-contextual risk perspective. A theoretical model of these processes is presented, along with practice and policy implications. [ABSTRACT FROM PUBLISHER]

Aim: To examine the effects of integrated treatment programmes (those with addiction services and pregnancy-, parenting- or child-related services) on length of stay and treatment completion. Methods: We systematically reviewed studies published between 1990 and 2008 comparing integrated programmes with non-integrated programmes on length of stay (number of studies [ K] == 3, number of participants [ n] == 1910) and treatment completion ( K == 6, n == 2556). We performed meta-analyses using standardized mean differences ( d) of effect size estimates. Findings: There was a significant advantage of integrated treatment programmes over non-integrated treatment in the number of days women spent in treatment ( d == 0.35, p < 0.0001) but not treatment completion ( d == 0.38, p == 0.09). Conclusions: This meta-analysis is the first systematic quantitative review of studies evaluating the impact of integrated programmes. Findings suggest that integrated programmes may be associated with a small advantage over non-integrated programmes in length of stay. This review highlights the need for further research with improved methodology, quality, and reporting to improve our understanding of how best to engage, retain and support mothers with substance abuse issues in treatment. [ABSTRACT FROM AUTHOR]

Objective: To inform a shared care model between developmental and behavioural (DB) and mental health specialists and primary care physicians by having members of primary care family health teams (FHTs) report on strengths of and barriers to providing care for children with DB disorders and mental health concerns., Design: Qualitative study using semistructured focus groups., Setting: Academic and community-based FHTs in Toronto, Ont., Participants: Primary care physicians, nurses, allied health professionals, and family medicine trainees within the participating FHTs., Methods: Nine focus groups were conducted with FHT members, and transcripts were analyzed for key themes using an inductive thematic analysis approach., Main Findings: Eighty-four participants across 9 sites were interviewed. Six sites were academically affiliated and 3 were community based. Participants described their roles in the care of children with DB disorders as primarily "referral agent" but also as "long-term supporter" and "health care coordinator." Family health team members expressed the desire to "learn" and "do more" for these children but noted numerous barriers to providing care, captured in 4 overarching themes: limited training beyond how to screen, lack of service knowledge, limited time and communication, and cumbersome access to mental health and dual diagnosis services., Conclusion: Primary care physicians are in the unique position of being able to provide longitudinal care for children with DB and mental health disorders. However, they perceive barriers to providing care that can affect access to services, service quality, and health outcomes for these children and their families. The health system might benefit from addressing these barriers by providing more training for primary care physicians in the longitudinal care of children with mental health and DB disorders, and by improving communication between FHTs and DB and mental health specialists regarding service navigation and emerging comorbidities. A shared care model integrating DB and mental health specialists into primary care might be one approach that warrants implementation and research., (Copyright© the College of Family Physicians of Canada.)