Integrated Treatment Programmes for Mothers with Substance Use Problems: A Systematic Review and Meta-analysis of Interventions to Prevent Out-of-home Child Placements

Approximately half of mothers receiving substance use treatment are involved with childcare proceedings. This review aims to determine whether integrated treatment programmes for mothers with substance use problems are effective in preventing out-of-home placement (temporally/permanent) and influencing other maternal factors such as patterns of substance use, treatment completion and parenting behaviours. Six trials were identified—two randomised controlled trials and four non-randomised controlled studies. The pooled sample of participants was 1717. The results showed that mothers who participated in integrated treatment programmes were significantly less likely to have the children removed from their care (Odds Ratio (OR)?=?0.40, 95% CI?=?0.27, 0.61), more likely to complete substance use treatment (OR?=?3.01, 95% CI?=?1.79, 5.06), and more likely to reduce their alcohol consumption (Standardised Mean Difference (SMD)?=??0.40, 95% Cl?=??0.78, ?0.01) and drug use (SMD?=??0.30, 95% CI?=??0.53, ?0.07). However, non-significant reductions were observed for parent–child conflict (SMD?=??0.35, 95% CI?=??0.72, 0.03) and child abuse risk (SMD?=??0.03, 95% CI?=??0.36, 0.31). While the findings from this review suggest that mothers involved in integrated treatment programmes could potentially be less likely to experience out-of-home child placements and more likely to improve substance use treatment outcomes, little evidence exists for the effectiveness of these interventions. Further research, particularly high-quality RCTs, is required to demonstrate and persuade health and public policy on the far-reaching value of the integrated approaches.

     

Clinical Implications for Multi-Racial Individuals

Abstract

Multi- racial individuals experience distinctive struggles and challenges that can impact their mental health. However, despite the growing population and unique presenting issues there remains a scarcity of literature to effectively support them. In addition, there is a lack of research exploring the unique experience of the multiple heritage population. The article offers implications for effectively working with individuals of multi-racial decent as well as a call to action for MFTs to develop multicultural competencies for the profession.     

Sketching while narrating as a tool to detect deceit

In none of the deception studies that used drawings to date, was the effect of sketching on both speech content and drawing content examined, making it unclear what the full potential is of the use of drawings as a lie detection tool. A total of 122 truth tellers and liars took part in the study who did or did not sketch while narrating their allegedly experienced event. We formulated hypotheses about the total amount of information and number of complications reported and about various features of the drawings. Participants in the Sketch-present condition provided more information than participants in the Sketch-absent condition, and truth tellers reported more details than liars, but only in the Sketch-present condition. In contrast to previous research, no Veracity differences occurred regarding the content of the drawings, perhaps because sketching was introduced as a tool that facilitated verbal recall and not as a stand-alone tool.     

Two-year-olds' search strategies and visual tracking in a hidden displacement task

Children younger than 3 years have difficulty with search tasks that involve hidden displacement. Partial visual information was provided about a ball's path as it moved toward a hiding place. Children (2.0 and 2.5 years old) saw a ball rolling down a ramp placed behind a transparent screen with 4 opaque doors. A wall, placed on the ramp and directly behind 1 of the doors, protruded above the screen and stopped the ball. Children were asked to find the ball. The transparency of the screen permitted visual tracking of the ball between the doors, but its final resting place was obscured. Both age groups were equally proficient at tracking the ball as it rolled behind the screen, but the 2.5-year-olds were more likely to reach to the correct door. Looking behavior was related to errors in the younger group in that tracking that stopped short or continued past the correct door was associated with incorrect choices.     

Maladaptive conflict monitoring as evidence for executive dysfunction in children with chromosome 22q11.2 deletion syndrome

Using an adaptation of the Attentional Networks Test, we investigated aspects of executive control in children with chromosome 22q11.2 deletion syndrome (DS22q11.2), a common but not well understood disorder that produces non-verbal cognitive deficits and a marked incidence of psychopathology. The data revealed that children with DS22q11.2 demonstrated greater difficulty than controls in locating and processing target items in the presence of distracters. Importantly, children with DS22q11.2 showed a deficit in the ability to monitor and adapt to stimulus conflict. These data provide evidence of inadequate conflict adaptation in children with DS22q11.2, a problem that is also present in schizophrenia. The findings of specific executive dysfunction in this group may provide a linkage between particular genetic abnormalities and the development of psychopathology.     

On the Tedium of the Good

It seems to be a phenomenon of contemporary life that we consider goodness embarrassing and rather dull. In contrast, the activities and inner lives of villains are deemed more complex and fascinating than those of good people. This paper attempts to understand the conception of goodness that underlies this phenomenon, and I suggest that informing it is the combination of two ideas, in tension with each other: firstly, a distorted understanding of the ancient conception of full virtue as the absence of all inner conflict; and secondly, the intuition that real goodness is only apparent and generated in inner conflict. In response, I offer an alternative picture of goodness as an ongoing, active and progressive relation to value, and conclude that in order to render goodness attractive again we need more adequate portraits of goodness from both philosophy and art.     

THE EFFECTS OF THE QUESTION “WHAT IS THIS?” ON TACT-TRAINING OUTCOMES OF CHILDREN WITH AUTISM

Tact training is a common element of many habilitative programs for individuals with developmental disabilities. A commonly recommended practice is to include a supplemental question (e.g., “What is this?”) during training trials for tacts of objects. However, the supplemental question is not a defining feature of the tact relation, and prior research suggests that its inclusion might sometimes impede tact acquisition. The present study compared tact training with and without the supplemental question in terms of acquisition and maintenance. Two of 4 children with autism acquired tacts more efficiently in the object-only condition; the remaining 2 children acquired tacts more efficiently in the object + question condition. During maintenance tests in the absence of the supplemental question, all participants emitted tacts at end-of-training levels across conditions with no differential effect observed between training conditions.Key words: autism, language training, stimulus control, tacts, verbal behaviorSkinner (1957) defined the tact as a response “evoked by a particular object or event or property of an object or event” (p. 82) and considered it to be one of the most important verbal operants. Tacts are maintained by generalized social reinforcement and, thus, they are central to many social interactions. For example, the tact “That cloud looks like a horse” (under the control of a visual stimulus) could evoke a short verbal interaction about the sky or horses. The tact “My tummy hurts” (under the control of an interoceptive stimulus) could evoke soothing statements from a parent. A child who tacts “doggie” in the presence of a cat likely would evoke a correction statement from an adult, further refining two stimulus classes (i.e., dog and cat). These examples illustrate that, despite their topographical differences, the tact relations share antecedent control by a nonverbal discriminative stimulus (S^D) and are maintained by generalized social reinforcement.In habilitative programs for individuals with language impairments, autism, and intellectual disabilities, tacts often are taught for objects (e.g., ball), object features (e.g., color, size, shape), activities (e.g., jumping), prepositions (e.g., between), and emotions (e.g., sad) among others. Although conceptualized differently among therapeutic approaches, the tact relation occupies a central position in many early-intervention curricula. For example, Lovaas (2003) and Leaf and McEachin (1999) describe these relations as expressive labels and recommend that they be taught early in language training using three-dimensional objects accompanied by the supplemental questions “What is it?” or “What''s this?” Alternatively, Sundberg and Partington (1998) explicitly refer to the relation as a tact and recommend beginning instruction by including the question “What is it?” before eventually fading the question. In addition to these clinical manuals, the use of supplemental questions during tact training has appeared in some empirical studies on tact or expressive-label training (e.g., Braam & Sundberg, 1991; Coleman & Stedman, 1974), but not others (e.g., Williams & Greer, 1993). Regardless of whether tact training initially includes supplemental questions prior to response opportunities, tacts ultimately should be emitted readily under the sole control of the nonverbal S^D as well as when it happens to be accompanied by a question.Conceptually, at least four potential problems could arise from introducing supplemental questions early and consistently in tact training. First, the acquired responses might not be emitted unless the question is posed (i.e., prompt dependence). This problem would lead to few spontaneous tacts occurring outside the explicit stimulus control of the training environment. Williams and Greer (1993) compared comprehensive language training conducted under the stimulus control specified in Skinner''s (1957) taxonomy of verbal behavior to a more traditional psycholinguistic perspective with supplemental questions and instructions embedded within trials. For all three adolescents with developmental disabilities, the targets taught from the verbal behavior perspective were maintained better in natural contexts than those taught from the psycholinguistic perspective. However, because data were not reported for each individual verbal operant, it is unclear what specific impact their tact-training procedures had on the outcomes.The second potential problem is that the supplemental question might acquire intraverbal control over early responses and interfere with the acquisition of subsequent tact targets. For example, Partington, Sundberg, Newhouse, and Spengler (1994) showed that the tact repertoire of a child with autism had been hindered by prior instruction during which she was asked “What is this?” while being shown an object. The supplemental question subsequently evoked previously acquired responses and blocked the ability of new nonverbal S^Ds (i.e., objects) to evoke new responses. Partington et al. then showed that new tacts were acquired by eliminating the supplemental question from instructional trials.The third potential problem is that learners might imitate part of or the entire supplemental question prior to emitting the target response (e.g., “What is it” → “What is it … ball.”). For example, Coleman and Stedman (1974) demonstrated that a 10-year-old girl with autism imitated the question “What is this?” while being taught to label stimuli depicted in color photographs. Such an outcome results in a socially awkward tact repertoire and requires additional intervention to remedy the problem.Finally, including supplemental questions during tact training might impede skill acquisition, perhaps via a combination of the problems described earlier. Sundberg, Endicott, and Eigenheer (2000) taught sign tacts to two young children with autism who had prior difficulty acquiring tacts. In one condition, the experimenter held up an object and asked, “What is that?” In the comparison condition, the experimenter intraverbally prompted the participant to “sign [object name]” in the presence of the object. Sundberg et al. demonstrated substantially more efficient tact acquisition under the sign-prompt condition than when the question “What is that?” was included in trials; the latter condition sometimes failed to produce mastery-level responding.Teaching an entire tact repertoire while including supplemental questions (e.g., “What is it?”) during training trials could produce a learner who is able to talk about his or her environment only when asked to do so with similar questions. To the extent that this is not a therapist''s clinical goal, teaching the tact under its proper controlling variables may eliminate such problems. Of course, inclusion of supplemental questions during the early phases of language training could be faded over time such that the target tact relation is left intact prior to the end of training (Sundberg & Partington, 1998). However, the aforementioned studies have documented problems with using supplemental questions during tact training. Given the ubiquity of tact training in habilitation programs, the numerous problems that may arise when supplemental questions are included in training trials, and the limited research on the topic, further investigation is warranted. Thus, the purpose of the present study was to compare directly the rate of acquisition and subsequent maintenance of tacts taught using only a nonverbal S^D (i.e., object only) with tacts taught using a question (“What is this?”) in conjunction with the nonverbal S^D (i.e., object + question). The present study extends earlier research by examining both acquisition and maintenance and by including individuals with no prior history of formal tact training.