title: Integrated programs for mothers with substance abuse issues and their children: a systematic review of studies reporting on child outcomes.
abstract: BACKGROUND
  Integrated treatment programs (those that include on-site pregnancy-, parenting-, or child-related services with addiction services) were developed to break the intergenerational cycle of addiction, potential child maltreatment, and poor outcomes for children.
  
  
  OBJECTIVE
  To examine the impact and effects of integrated programs for women with substance abuse issues and their children, we performed a systematic review of studies published from 1990 to 2011.
  
  
  METHODS
  Literature search strategies included online bibliographic database searches, checking printed sources, and requests to researchers. Studies were included if all participants were mothers with substance abuse problems at baseline; the treatment program included at least 1 specific substance use treatment and at least 1 parenting or child treatment service; the study design was randomized, quasi-experimental, or cohort; and there were quantitative data on child outcomes. We summarized data on child development, growth, and emotional and behavioral outcomes.
  
  
  RESULTS
  Thirteen studies (2 randomized trials, 3 quasi-experimental studies, 8 cohort studies; N=775 children) were included in the review. Most studies using pre-post design indicated improvements in child development (with small to large effects, ds=0.007-1.132) and emotional and behavioral functioning (with most available effect sizes being large, ds=0.652-1.132). Comparison group studies revealed higher scores for infants of women in integrated programs than those not in treatment, with regard to development and most growth parameters (length, weight, and head circumference; with all available effect sizes being large, ds=1.16-2.48). In studies comparing integrated to non-integrated programs, most improvements in emotional and behavioral functioning favored integrated programs and, where available, most effect sizes indicated that this advantage was small (ds=0.22-0.45).
  
  
  CONCLUSIONS
  Available evidence supports integrated programs, as findings suggest that they are associated with improvements in child development, growth, and emotional and behavioral functioning. More research is required comparing integrated to non-integrated programs. This review highlights the need for improved methodology, study quality, and reporting to improve our understanding of how best to meet the needs of children of women with substance abuse issues.
authors.affiliation: 280 Holbrook Building, McMaster Children's Hospital-Chedoke Site, Box 2000, McMaster University, Hamilton, Ontario, Canada L8N 3Z5.
authors.forename: Alison
authors.initials: A
authors.lastname: Niccols
authors.forename: Karen
authors.initials: K
authors.lastname: Milligan
authors.forename: Ainsley
authors.initials: A
authors.lastname: Smith
authors.forename: Wendy
authors.initials: W
authors.lastname: Sword
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.forename: Joanna
authors.initials: J
authors.lastname: Henderson
mesh_terms: D000553:Ambulatory Care; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D002669:Child Welfare; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D002658:Developmental Disabilities / Q000517:prevention & control* / Q000523:psychology; D004644:Emotions; D005260:Female; D006130:Growth Disorders / Q000209:etiology; D006801:Humans; D009035:Mothers / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control; D011379:Prognosis; D019966:Substance-Related Disorders; D014932:Women's Health Services / Q000458:organization & administration*