Scientific Abstract


Presented at the 14th International Family Nursing Conference in Washington DC, August 13-16, 2019.

 

Supporting Families in the Context of Substance Abuses:
Perceptions of Key Informants

Authors: J. Tye, S. Meiers, G. Olsen, M. Moore, M. Aleman, P. Hoffman, V. Chawla

 

Background: Addiction is considered a family disease, and a child raised in a family affected by substance use disorder (SUD) is at increased risk for developmental, emotional, academic, behavioral and substance use problems. Their risk of developing SUD themselves is three to four times higher than children raised in non-addicted families. SUD disrupts fundamental aspects of family functioning including parent-child attachment, roles, routines, communication patterns, social life, and finances. Families affected by SUD often exhibit secrecy, shame, loss, conflict, violence, chaos, role reversal and fear. Substance abuse is also associated with other adverse experiences including mental illness, incarceration, divorce and violence. Because of the disruptive impact on children, other adults including grandparents, other relatives and foster parents often step in to care for the children. Challenges faced by these adults include financial stress, legal issues, lack of social support, isolation, strained family relationships, and health problems. 

 

Purpose: The purpose of this study was to explore the needs of children and caregivers in families affected by substance abuse as perceived by professionals within the community who interact with families coping with SUD.

Methods: A community-based participatory research (CBPR) approach with exploratory and descriptive methods was employed to explore the significance of the problem for the community. Data were collected by semi-structured interviews designed to assess awareness of the impact of addiction on children and caregivers, available resources and services, and gaps in services. Nineteen interviews were conducted with key professionals including social workers, physicians, educators, mental health providers, law enforcement professionals, legal experts and others. Interviews were recorded and professionally transcribed. Themes and subthemes were determined by qualitative content analysis methods.

 

Results: Data were detailed and compelling making it difficult to capture the richness in a brief summary. Three major themes emerged and multiple subthemes were identified.

Theme One: Contextual and system issues impacting families affected by SUD. Subthemes included:

  • The nature of SUD and the impact on the family. SUD

    • Creates chaos, seems never-ending, and is intergenerational

    • Carries stigma

    • Has cultural meaning

    • Can co-occur with mental illness

    • Increases risk for shame, guilt, disruption of trust, abuse, and neglect

    • Leads to social isolation and families often suffer in silence

  • Professionals are uncertain about the prevalence of and the influence of substance abuse on children and caregivers.

  • Laws, processes, and policies that criminalize substance abuse influence professional intervention and child-parent-caregiver interactions.

  • Professional approaches are based on values, norms, and institutional practices.

  • The life-course of the child and the caregiver are influenced by the trajectory of substance abuse and interactions across systems.

Theme Two: Impact on children affected by family addiction. Subthemes included:

  • Needs vary depending on age and situation (e.g., trauma, abuse, separation, etc.)

  • Children are at increased risk for abuse, neglect, developmental, emotional, behavioral and academic problems

  • Children may have life-long effects on mental and physical health, relationships, and employment pathways

  • Children need to have:

    •  Basic needs met: safety, food, housing, transportation

    • Stability and consistency

    • Protection from risks

    • Relationships with adults they can trust

    • Emotional support including understanding of the disease; healthy coping; recognizing, labeling and expressing feelings; and “sharing” secrets

    • Connections with family, school, and community

    • Advocacy and assistance with navigation of systems (e.g., legal, educational, medical, financial, insurance, housing, child protection services).

Theme Three: Needs of adult caregivers who step in to help care for these children:

  • Needs vary according to caregiver situation (employed, retired, age, income, state of health).

  • Many care for children in isolation without professional/community support.

  • Caregivers need support in

    • Navigating the legal, educational, medical, financial, insurance, housing, child protection systems

    • Managing role conflict (e.g. between parent role/grandparent role; co-parenting with biological parent; competing concerns for their own addicted child and grandchildren)

    • Knowledge and skills in raising/supporting children who have been traumatized

    • Emotional support in dealing with heartache, fear, depression, shame, and guilt

    • Managing role overload (e.g. work obligations, caregiver fatigue)
       

Limitations:

  • The study was based on a convenience sample from a small Midwestern city. The sample consisted of middle-class, professional, primarily Caucasian citizens of the United States with limited diversity. Thus findings may not be generalizable to the other populations and settings.

  • The perceptions of needs of children and caregivers are second person perceptions from key informants.

  • Perceptions regarding families “outside of the system” who may not interact with professionals are minimally represented.
     

Conclusions:

  • All participants expressed concern for children affected by substance use disorder. Many, however, indicated that their primary responsibility was the individual affected by SUD rather than the family.

  • The impact of SUD on families is often pervasive and profound.

  • There was a significant variation in awareness of the age-specific needs of children.

  • In spite of the crucial role played by adult caregivers, their needs remain largely unexplored and unaddressed.

  • A standardized or evidence-based approach to addressing the needs of children and caregivers was not evident. Approaches varied widely and were more likely to be based on contextual variables such as professional philosophy, roles and values, rather than evidence.

  • Professionals tended to approach involvement with families within the context of their job descriptions and employer parameters.  Although many interviewees indicated an awareness of the need to improve care for children and caregivers, the opportunity or encouragement to generate solutions was not necessarily provided within their agencies.