Parenting behavior is important for ALL families. It has been described as the single most important contributor to healthy child development and well-being as it results in secure attachment, protects against childhood neglect and abuse, encourages the child’s social development, and guards against toxic stress. For substance using mothers, parenting assessment and intervention are critical, as these mothers are at high risk for maladaptive parenting and high parenting stress, affecting the healthy development of their children.
Guest Blog by
Diane Abatemarco, PhD, MSW, Project Director
Meghan Gannon, PhD Candidate, Project Coordinator
Jefferson/Nemours Dept. of Pediatrics, Nemours Children’s Health System
The Practicing Safety Mindfulness Project for Mothers in Drug Treatment (PSMDT) is examining a multi-faceted intervention that includes:
- Mindfulness Based Parenting instruction,
- Practicing Safety, a pediatric quality improvement intervention, and
- Enhanced case management.
Mindfulness Based Parenting
The MBP parenting intervention consists of 2-hour Mindfulness Based Parenting (MBP) sessions for twelve weeks at Family Center. The curriculum incorporates mother/baby dyad education, knowledge of the impact of trauma and early parenting, brief formal meditation practices, and emphasis on short informal practices.
The major themes of MBP are woven throughout the sessions, including:
Listening with full attention - correctly discerning child’s behavior cues, accurately perceiving child’s verbal communication
Nonjudgmental acceptance of self and child - healthy balance between child, parent, and relationship needs, sense of parenting self-efficacy
Emotional awareness of self and child - responsiveness to child needs and emotions
Self-regulation - emotional regulation in parenting, parenting with goals and values
Compassion for self and child - positive affection in parent child relationship and more forgiving view of own parenting efforts.
At the conclusion of the 12-week program, the women are invited to a celebration lunch where they receive a certificate for their completion of the Mindfulness Based Parenting (MBP) program, and are honored for their hard work in self-care and positive parenting.
One Mother’s Reflections on Her Parenting after MBP
Parenting is one of the most challenging, demanding and stressful jobs on the planet. Although I may not have control over many of the stressors that come along with parenting, I do have control over the way I respond to them. When I make the decision to respond to any given situation rather than automatically reacting to it, I am practicing mindfulness. Mindfulness is about paying attention to the present moment, on purpose, without judgment. I myself have two wonderful children, ages 3 and 1, both girls. Needless to say I encounter many stressful moments on a daily basis; scream your head off, pull your hair out, lock your kids in the closet kind of moments! The Mindful-Based Parenting (MBP) group has opened my mind to a more calm, cool, and collective approach to parenting instead of a kicking, biting and screaming approach. The group has taught me useful techniques that allow me to listen to my kids, pay attention to their feelings, and control my own emotions with compassion and, best of all, without judgment. Not only has MBP made a tremendous difference in the way I parent but it has helped me to form better relationships in other areas of my life as well.
-- Kelliann, participating mother in MBP Project
Do Data Show Mindfulness Based Parenting Makes a Difference?
To evaluate whether the MBP project changes the lives of mothers and their children, we collect pre and post intervention measures including the Keys to Interactive Parenting Scale, Adverse Childhood Experience tool, Knowledge of Infant and Child Development, Parenting Stress Inventory, Five Facets of Mindfulness, Interpersonal Mindfulness Scale, Perceived Stress Scale, practice measures, and demographic information.
Why Choose KIPS? We chose the Keys to Interactive Parenting Scale (KIPS) to address parenting behaviors because of the growing diversity and unique needs of our vulnerable study population. We sought an effective and culturally appropriate observational parenting assessment. We found KIPS to be more culturally sensitive than other parenting observational measures (as well as less costly and less cumbersome). Specifically relevant, the KIPS tool has been found to be sensitive enough to detect changes in parenting behavior in the population of those with substance use disorders in previous AIA projects. We especially valued KIPS’ ability to allow parents to demonstrate high quality behaviors in a variety of ways.
KIPS and Attachment. As previous work demonstrates the importance of a secure attachment in the mother/baby dyad, we aimed to examine the effect of the MBP intervention on this attachment, which is often impaired in substance using families. As noted in a previous guest blog on the parent-child relationship and attachment, the KIPS assessment examines specific parameters of the theory of attachment, such as physical interactions (touch, proximity), voice tones (verbal communication), showing interest, reading cues by attending to signals, and preventing discipline problems (setting limits and consequences). KIPS also contains several elements of the secure base phenomenon (within the attachment construct) such as actively joining in child’s play, consoling if child is upset, responding to cues of child, expanding play, adjusting play, supporting confidence, and supporting emotions.
Preliminary Data of the MBP Project (N=55) show the participating women to be mostly unmarried (91.7%), using Medicaid (86.1%), Caucasian (91.2%), non-Hispanic (91.2%), with a history of depression (73.1%). The average age is 30 with 2-3 children. KIPS baseline scores revealed low quality parenting (M=2.43). Of the clinical areas on KIPS, the highest quality parenting was seen in “Building Relationships” (M=2.61), followed by “Supporting Confidence” (M=2.41), and “Promoting Learning” (M=2.27). Additional cohorts of data are being collected, as well as more follow-up data which will inform whether the MBP intervention has an effect on quality of parenting. Rich qualitative data collected from the KIPS score sheet will also describe the parenting of mothers in substance abuse treatment, as well as the impact of our intervention. We have found that all of our mothers are comfortable with the KIPS assessment, and our staff has found tremendous value in its ability to examine parenting and attachment dimensions. We look forward to sharing future progress on this project and results from this intervention.
Multidisciplinary Staffing and Setting
This project recruits pregnant and parenting women who are enrolled in medically assisted treatment for opioid dependence from the Maternal Addiction Treatment Education and Research Program (MATER) at Thomas Jefferson University through Family Center (women’s outpatient) and My Sisters Place (family residential). This project is funded by an Abandoned Infants Assistance (AIA) grant from the federal Children’s Bureau, Administration of Children & Families, and directed by Principal Investigator Dr. Diane Abatemarco at Jefferson/Nemours Department of Pediatrics in Philadelphia. The PSMDT multidisciplinary research team includes experts in the field of pediatric population health, quality improvement, mindfulness, trauma informed care, and medically assisted treatment for opioid dependence. The team includes nationally recognized researchers, MDs, a social worker, a case worker, clinical staff at MATER, and mindfulness based parenting teachers. The innovative curriculum has been developed iteratively, responding to the needs of the mothers in medically assisted treatment. Dr. Abatemarco is also currently conducting a Mindfulness Based Childbirth and Parenting (MBCP) Research Project, funded by the March of Dimes, at Thomas Jefferson University’s OB/GYN clinic, investigating if MBCP mitigates preterm labor incidence in urban African American women.
Read more about our work with Pediatric Practice Transformation and Practicing Safety Mindfulness for Mothers in Drug Treatment at the following two websites:
Download the Keys to Interactive Parenting Scale (KIPS) Validation Summary
KIPS was validated with support from the National Institute of Child Health and Human Development. Download highlights of the research showing that KIPS is valid, reliable and practical for use in programs serving diverse families.