title: Integrated programs for women with substance use issues and their children: a qualitative meta-synthesis of processes and outcomes.
abstract: BACKGROUND
  There is a need for services that effectively and comprehensively address the complex needs of women with substance use issues and their children. A growing body of literature supports the relevance of integrated treatment programs that offer a wide range of services in centralized settings. Quantitative studies suggest that these programs are associated with positive outcomes. A qualitative meta-synthesis was conducted to provide insight into the processes that contribute to recovery in integrated programs and women's perceptions of benefits for themselves and their children.
  
  
  METHODS
  A comprehensive search of published and unpublished literature to August 2009 was carried out for narrative reports of women's experiences and perceptions of integrated treatment programs. Eligibility for inclusion in the meta-synthesis was determined using defined criteria. Quality assessment was then conducted. Qualitative data and interpretations were extracted from studies of adequate quality, and were synthesized using a systematic and iterative process to create themes and overarching concepts.
  
  
  RESULTS
  A total of 15 documents were included in the meta-synthesis. Women experienced a number of psychosocial processes during treatment that played a role in their recovery and contributed to favourable outcomes. These included: development of a sense of self; development of personal agency; giving and receiving of social support; engagement with program staff; self-disclosure of challenges, feelings, and past experiences; recognizing patterns of destructive behaviour; and goal setting. A final process, the motivating presence of children, sustained women in their recovery journeys. Perceived outcomes included benefits for maternal and child well-being, and enhanced parenting capacity.
  
  
  CONCLUSIONS
  A number of distinct but interconnected processes emerged as being important to women's addiction recovery. Women experienced individual growth and transformative learning that led to a higher quality of life and improved interactions with their children. The findings support the need for programs to adopt practices that focus on improving maternal health and social functioning in an environment characterized by empowerment, safety, and connections. Women's relationships with their children require particular attention as positive parenting practices and family relationships can alter predispositions toward substance use later in life, thereby impacting favourably on the cycle of addiction and dysfunctional parenting.
authors.affiliation: School of Nursing, McMaster University, Hamilton, Ontario, Canada. sword@mcmaster.ca
authors.forename: Wendy
authors.initials: W
authors.lastname: Sword
authors.forename: Susan
authors.initials: S
authors.lastname: Jack
authors.forename: Alison
authors.initials: A
authors.lastname: Niccols
authors.forename: Karen
authors.initials: K
authors.lastname: Milligan
authors.forename: Joanna
authors.initials: J
authors.lastname: Henderson
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane