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Program Profile: Engaging Moms Program

Evidence Rating: Promising - One study Promising - One study

Randomized Controlled Trial

Date: This profile was posted on May 26, 2011

Program Summary

A gender-specific, family-based intervention designed to help substance-abusing mothers participating in drug court maintain their parental rights. The program is rated Promising. Mothers who participated in the program showed equal or better improvement than those who received Intensive Case Management Services for all outcomes. Mothers who participated were more likely to have positive child welfare outcomes.

Program Description

Program Goals
The Engaging Moms Program (EMP) is a gender-specific, family-based intervention designed to help substance-abusing mothers participating in drug court maintain their parental rights. The program helps mothers demonstrate that they can be reunited with their children. It provides mothers the tools and services to comply with all court orders, attend court sessions, remain drug-free, and demonstrate the capacity to parent their children, thereby helping them to succeed in drug court.

Program Theory/Program Components
EMP was adapted for use in family drug court using the theory and method of multidimensional family therapy (Liddle, Dakof, and Diamond 1991). EMP’s program theory maintains that change in six core areas is essential for drug-using mothers to achieve sobriety and adequately care for her children. The six core areas of change include:
  • Mother’s motivation and commitment to succeed in drug court and to change her life
  • The emotional attachment between the mother and her children
  • Relationships between the mother and her family of origin
  • Parenting skills
  • Mother’s romantic relationships
  • Emotional regulation, problem solving, and communication skills
To achieve change in these core areas, EMP counselors hold integrated individual and family sessions with the mother and her family (e.g., individual sessions with the mother, individual sessions with family/partner, family and couple sessions). The EMP intervention is organized into three stages:

Stage 1: Alliance and Motivation
During the first stage, EMP counselors focus on two main goals: (1) building a strong therapeutic relationship with the mother and her family, and (2) enhancing the motivation of the mother to participate in drug court and to change. Counselors provide support to the mother and her family by highlighting strengths and competence, building confidence in the program, offering compassion, and maintaining a nurturing attitude throughout. Counselors enhance motivation by highlighting the pain, guilt, and shame that the mother and her family have experienced and the high stakes involved (such as losing a child to the child welfare system), while at the same time creating positive expectations and hope.

Stage 2: Behavioral Change
The second stage of EMP focuses on behavioral change of the mother and her family/spouse. Counselors begin by trying to enhance the emotional attachment between the mother and her children by working individually with the mother to help her explore her maternal role. The mother-and-children sessions are also designed to enhance the mother’s commitment to her children. In addition, counselors focus on enhancing the attachment between the mother and her family and/or spouse. This is accomplished by working with the family to help them refrain from negativity and instead offer instrumental and emotional support to the mother. Significant attention is devoted to repairing the mother’s relationship to her family, which may have been damaged by hurts, betrayals, and resentments in the past.

The EMP program also addresses romantic relationships, typically with men, which are often a source of pain and distress for many mothers involved in the child welfare system. Mothers in the program work with a counselor to conduct a relationship life review, which includes examining tensions between having a romantic relationship and being a mother. The counselor helps the mother examine the choices she had made and continues to make with regard to romantic relationships, and teaches her how to make better decisions for herself and her children. Counselors also help the mother deal with any slips, mistakes, setbacks, or relapses in a non-punitive and therapeutic manner.

Finally, EMP counselors facilitate the mother’s relationship with treatment/service providers and drug court personnel, including the judge, child welfare workers, and attorneys. Counselors conduct “shuttle diplomacy” between the mother and service providers that is designed to prevent and resolve any problems and allow the mother to make the most use of the services being provided to her. In addition, counselors facilitate the therapeutic jurisprudence in the courtroom by preparing mothers for court appearances and advocating for the mother in front of the judge and during weekly drug court case reviews.

Stage 3: Launch to an Independent Life
In the final stage, EMP counselors work with the mother to prepare her for an independent life. This includes developing a practical and workable routine for everyday life; addressing how the mother will balance self-care, children, and work; outlining a plan to address common emergencies with children and families; and addressing how the mother will deal with potential problems, mistakes, slips, and relapses.

Evaluation Outcomes

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Study 1
The study by Dakof and colleagues (2010) looked at the comparative effects of two family drug court interventions and found statistically significant differences between the groups on a number of measures. Mothers who participated in the Engaging Moms Program (EMP) showed equal or better improvement than mothers who received Intensive Case Management Services (ICMS) on all outcomes.

Child Welfare Status
Mothers who participated in EMP were more likely than mothers in ICMS to have positive child welfare outcomes (defined as welfare dispositions that led to sole custody, joint custody, or permanent guardianship with family members, without termination of the mother’s parental rights). Eighteen months after enrollment in family drug court, 77 percent of EMP mothers had positive child welfare outcomes, compared to 55 percent of ICMS mothers.

Maternal Substance Use, Psychosocial, and Family Functioning
There were no statistically significant differences between the two intervention groups on these measurements, due to the small sample size. The effect sizes of several outcomes did favor mothers who participated in EMP, however. The positive effects are seen in the first 3 months of the follow-up period, and in each case, these initial treatment differences were maintained through 18 months.

The calculated effect sizes showed that EMP mothers were more likely to decrease their alcohol use, experience improvement in their mental health (as measured by the Brief Symptom Inventory), improve their overall family functioning, and decrease their risk for child abuse compared to ICMS mothers. There were no significant differences on measures of drug use, with mothers from both groups showing significant improvement over time. Mothers participating in EMP also showed greater improvements with medical problems between 3 months and 18 months.
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Evaluation Methodology

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Study 1
Dakof and colleagues (2010) used an intent-to-treat design to examine the effectiveness of the Engaging Moms Program (EMP) in comparison to Intensive Case Management Services (ICMS). The EMP intervention was implemented in a dependency drug court (DDC) of the State of Florida 11th Circuit Judicial Juvenile Court in Miami, Fla. To be eligible to participate in the DDC, parents had to:
  • Be 18 years or older
  • Have at least one child adjudicated dependent
  • Have a diagnosis of substance abuse or dependence
  • Have a potential for family reunification
  • Voluntarily enroll in drug court
All mothers accepted into the DDC were eligible to participate in the study. Study staff met with mothers who were referred upon enrollment in drug court. After a baseline assessment of the mothers, they were randomly assigned to either ICMS (n= 31) or EMP (n= 31).

Mothers who participated in the study were adjudicated in a single drug court with one judge presiding (not the founding family drug court judge), and received the same types of substance abuse treatment, parenting interventions, and other services as ordered by the judge. The only difference between the treatment and comparison group was the intervention administered by the drug court counselors: EMP (treatment group) versus ICMS (comparison group).

There were no significant differences between the two groups. Mothers who participated in EMP were on average 29.1 years old, and were 45 percent African American, 36 percent Hispanic, and 19 percent white. Mothers who participated in ICMS were on average 31.2 years old, and were 39 percent African American, 35 percent Hispanic, and 26 percent white. Both groups had low monthly incomes, high unemployment, and had an average of 2.5 children.

All mothers were assessed at 3, 6, 9, 12, and 18 months following intake, regardless of the extent of their participation in drug court. The drug court was designed to last between 12 and 15 months; therefore, the 18-month follow-up is post–drug court participation. Analysis was conducted on the following outcomes: child welfare status; substance use, measured by urinalysis samples and Addiction Severity Index; family functioning, measured by the Addiction Severity Index; parenting practices, measured by Brief Child Abuse Potential I and Revised Conflict Tactics Scale; and maternal mental and physical health, measured by Brief Symptom Inventory and Addiction Severity Index. All data was collected during face-to-face interviews with participants at intake and the follow-up periods, except for information on child welfare status, which was gathered from court records.

Individual participants’ change was analyzed with the latent growth curve modeling method. Effect sizes were calculated using Feingold’s method for growth curve modeling. An intervention was considered to have an effect on study participants if the effect size of an outcome was d=0.5 or larger (considered a medium effect size).
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Cost

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There is no cost information available for this program.
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1

Dakof, Gayle A., Jeri B. Cohen, Craig E. Henderson, Eliette Durate, Maya Boustani, Audra Blackburn, Ellen Venzer, and Sam Hawes. 2010. “A Randomized Pilot of the Engaging Moms Program for Family Drug Court.” Journal of Substance Abuse Treatment 38:263–74.


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Additional References

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These sources were used in the development of the program profile:

Cohen, Jeri B., Gayle A. Dakof, and Eliette Duarte. 2011. “Dependency Drug Court: An Intensive Intervention for Traumatized Mothers and Young Children.” In Joy D. Osofsky (ed.). Clinical Work With Traumatized Young Children. New York, N.Y.: Guilford Press, 252–68.

Dakof, Gayle A., Tanya J. Quille, Manuel J. Tejeda, Linda R. Alberga, Emmalee Bandstra, and Jose Szapocznik. 2003. “Enrolling and Retaining Mothers of Substance-Exposed Infants in Drug Abuse Treatment.” Journal of Consulting and Clinical Psychology 71(4):764–72.

Dakof, Gayle A., Jeri B. Cohen, and Eliette Duarte. 2009. “Increasing Family Reunification for Substance-Abusing Mothers and Their Children: Comparing Two Drug Court Interventions in Miami.” Juvenile and Family Court Journal 60(4):11–23. (This study was reviewed but did not meet CrimeSolutions.gov criteria for inclusion in the overall program rating.)

Liddle, Howard A., Gayle A. Dakof, and Guy S. Diamond. 1991. “Adolescents and Substance Abuse: Multidimensional Family Therapy in Action.” In E. Kaufman & P. Kaufman (Eds.). Family Therapy Approaches with Drug and Alcohol Problems (2nd Edition). Gardner, 120–71.
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Program Snapshot

Age: 18+

Gender: Female

Race/Ethnicity: Black, Hispanic, White

Geography: Suburban, Urban

Setting (Delivery): Other Community Setting, Courts

Program Type: Alcohol and Drug Therapy/Treatment, Cognitive Behavioral Treatment, Drug Court, Family Court, Family Therapy, Gender-Specific Programming, Parent Training

Targeted Population: Females, Alcohol and Other Drug (AOD) Offenders, Families

Current Program Status: Active

Listed by Other Directories: Model Programs Guide

Program Developer:
Gayle Dakof
Research Associate Professor
University of Miami Miller School of Medicine
1425 NW 10th Avenue, 2nd Floor
Miami FL 33136
Phone: 305.243.3656
Fax: 305.243.3651
Email

Researcher:
Gayle Dakof
Research Associate Professor
University of Miami Miller School of Medicine
1425 NW 10th Avenue, 2nd Floor
Miami FL 33136
Phone: 305.243.3656
Fax: 305.243.3651
Email