title: Factors that influence mother-child reunification for mothers with a history of substance use: A systematic review of the evidence to inform policy and practice in Australia.
abstract: BACKGROUND
  An estimated 60-70% of Australian children in out of home care have a parent with a substance use disorder (SUD). The assessment of a parent's history and needs and the design of supportive interventions, particularly for mothers who are often the primary carers of children, are important considerations in deciding whether or not family reunification is desirable and possible. It is not clear from the research how the needs of families can be best met. There are no systematic reviews that provide evidence to inform the development of preventative and remedial interventions and related policy options. We undertook a systematic review to examine maternal characteristics and program features that facilitate or pose a barrier to mother-child reunification in contexts where mothers have a SUD.
  
  
  METHODS
  A structured search of nine databases was undertaken to identify peer reviewed literature in English between 2004 and 2014 and examine factors that influenced mother-child reunification in mothers with SUD. We employed a narrative synthesis design to analyse the findings sections of all papers as the methods of the various studies did not permit the pooling of data.
  
  
  RESULTS
  A total of 11 studies were included in this review. Findings show that factors such as timeliness of treatment entry, treatment completion and the receipt of matched services, and programs that provided a greater level of integrated care are positively related to reunification. The presence of a mental health disorder, use of opiates and having a greater number of children were barriers to reunification.
  
  
  CONCLUSIONS
  Women with SUD who have a child in out of home care appear to have multiple unmet needs. Accessible, stigma free and comprehensive integrated care services, as well as greater access to primary health care that address social and medical issues must be considered to improve the physical and psycho-social outcomes of these women and their children.
authors.affiliation: Faculty of Health, University of Technology Sydney, NSW, Australia. Electronic address: anna.doab@uts.edu.au.
authors.forename: Anna
authors.initials: A
authors.lastname: Doab
authors.affiliation: Faculty of Health, University of Technology Sydney, NSW, Australia; Tresillian Family Care Centres, NSW, Australia.
authors.forename: Cathrine
authors.initials: C
authors.lastname: Fowler
authors.affiliation: Faculty of Health, University of Technology Sydney, NSW, Australia.
authors.forename: Angela
authors.initials: A
authors.lastname: Dawson
mesh_terms: D001315:Australia; D002648:Child; D003695:Delivery of Health Care / Q000458:organization & administration; D005190:Family; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D009034:Mother-Child Relations; D009035:Mothers / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000534:rehabilitation
keywords: Child welfare and mothers; Out-of-home-care; Reunification; Substance abuse; Substance use disorders