(Illustration by Martín Castillo)

Helping Children Exposed to Substance Abuse, Mental Illness, and Violence (Part 1)

By Beryl Lieff Benderly

Renee, now a married mother of two young daughters, was 8 years old when she was sexually molested by an adult. "I didn't know that I could tell anyone," she said. "I thought I would get into trouble."

The abuse continued. In addition to this trauma, Renee later also experienced substance abuse and mental problems.

Then last year, a boy at school inappropriately touched Renee's daughter, Jennifer, in second grade at the time. Like Renee before her, Jennifer "didn't really think she had a voice" to object, Renee said. But now, thanks to an innovative intervention, Jennifer "knows she has a choice" about whether and how people touch her, according to Renee. "She sets boundaries for herself." Renee believes that Jennifer, armed with this vital knowledge, now stands a good chance of avoiding problems that marred her mother's life.

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SAMHSA's Study

Jennifer learned this essential lesson in a facilitated children's group funded by SAMHSA's Cooperative Agreement to Study Children of Women with Alcohol, Drug Abuse, and Mental Health Disorders Who Have Histories of Violence—known as the Children's Subset Study for short. The study seeks to identify models of care for the field that will prevent or reduce the intergenerational perpetuation of violence, substance abuse, and mental illnesses, and reduce the impact of violence in the lives of children whose mothers have co-occurring mental and addictive disorders and histories of trauma.

The study participants are the children of women enrolled in SAMHSA's ongoing Women, Co-Occurring Disorders, and Violence study, begun in 1998 to test interventions to help women who have experienced trauma and who have both substance abuse and mental illnesses. In 2000, 2 years into the study, SAMHSA launched the substudy aimed at finding ways to help the children of these women strengthen their ability to cope with experiences that threaten their safety and self-esteem.

Four of the participating women's sites—in Massachusetts, Colorado, and one each in northern and southern California—were chosen to participate in the Children's Subset Study.

All three SAMHSA Centers are participating in the study, which is funded by SAMHSA's Center for Substance Abuse Treatment (CSAT).

"We continue to see how this study provides the medium to learn about safety for children, the role of protective factors and resiliency, and the importance of teaching children alternatives to violence," said Melissa Rael, R.N., M.P.A., CSAT senior program management officer.

No previous research has systematically examined the combined effects on children exposed to all three risk factors, according to Jeanette Bevett-Mills, M.Ed., M.S., a public health advisor at SAMHSA's Center for Substance Abuse Prevention.

However, she said, "Past experience suggests that they are at high risk for substance abuse," highlighting the need to "break the intergenerational cycle" of substance abuse within affected families. "Because early experiences are crucial to development throughout the life cycle," she said, finding ways to help vulnerable children develop constructive ways to avoid substance abuse later in life appears to be a promising strategy.

Family histories of substance abuse, mental illnesses, and exposure to trauma may place children at risk for a range of mental health problems, according to Kana Enomoto, public health analyst in SAMHSA's Center for Mental Health Services. Although some of the study children receive individual counseling or psychotherapy, the study hypothesizes that group work among peers facing similar problems "can help in ways that individual interventions cannot," Ms. Enomoto said. Knowing that others also face these issues may help children develop greater understanding and effective coping strategies "in ways they cannot do alone," she added.

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Recruiting Participants

Jennifer attended group sessions in her hometown of Fall River, MA, at Stanley Street Treatment and Resources (SSTAR), one of two agencies in different parts of the state that are participating as a single study site. Called the Women Embracing Life and Living (WELL) Child Study, the project is supervised from offices in Cambridge by principal investigator Norma Finkelstein, Ph.D. The project will compare results from intervention sites where 30 children receive several specially designed services to those from a comparison site where 30 children receive what she calls "services as usual." Interviews with mothers or caretakers conducted every 3 months will provide outcome data.

Courtney (l.) and Jennifer (r.) with their mother, Renee, have benefited from the Women Embracing Life and Living (WELL) Child Study funded by SAMHSA’s Children’s Subset Study.

As participants enter the women's study through agency referrals, they are informed of the children's project and offered the opportunity to enroll their children.

Some mothers, however, refuse permission, though "they want obviously what's best for their kids," said Karen Gould, LICSW, project director of the WELL Child study. "They might say, 'This is wonderful.' But when a group starts, they say 'maybe this isn't such a good time.' " Perhaps they do not trust the agency, she suggested, or maybe they are "nervous about the fact that their child would hear things . . . that maybe no one had ever really talked about." Some may fear that their children will divulge sensitive family information.

Some, Dr. Finkelstein said, simply need "a little more sobriety, more recovery [before] they can focus on their children because they are mostly focused on themselves."

For mothers who do enter their children in the study, a clinical assessment of both parent and child comes next.

"By the time I meet the women for assessment," Ms. Gould said, "they know exactly what they're getting into and . . . they're very motivated. What they'll say is 'This is exactly what my child needs.' "

See Also—Article Continued: Part 2 »

See Also—Related Content—The Skills-Building Intervention »

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