Helping drug dependent parents and their children: Is Behavioural Couples Therapy a realistic option? Research Team Principal Investigator: Dr Anne Whittaker, University of Stirling Co-investigators: Professor Elliott (Glasgow Caledonian), Professor Taylor (Birmingham), Dr Klostermann (Medialle College, USA), Andy Stoddart (Edinburgh), Research Fellows: Heather Black, Dr Peter Hillen (Edinburgh Napier). Steering Committee Professor O’Farrell (Harvard, USA), Professor Weir (Edinburgh), Dr Littlewood (NHS Lothian), Dr Gill (Edinburgh Napier), 2 service users (mother & father). Funder: Chief Scientist Office Behavioural Couples Therapy (BCT) is a psychosocial intervention for the treatment of addiction recommended by NICE and the UK Department of Health. Evidence from the USA shows that BCT, when compared to individual-based treatment, improves abstinence rates and alcohol and drug-related harms, reduces domestic violence and can indirectly benefit children living in the home. However, evidence suggests that implementation of the intervention is limited within addiction services and BCT has not been evaluated in the UK. So we conducted first study of BCT in the UK, which aimed to test the feasibility of implementing and evaluating the intervention with parent-couples on opioid substitution therapy (OST) living with children aged 0-16 years.

A feasibility study Behavioural Couples Therapy (BCT) as an adjunct to opioid substitution therapy for drug dependent parents The intervention Study design Mixed methods Baseline data End-of-treatment data Qualitative interviews Couples Other parents Therapists Referrers The intervention itself is a 12 session manualised programme, delivered over a 3-4 month period. Our study involved the delivery of BCT to a target 18 couples. We collected baseline and end-of-treatment measures (substance use/couple functioning/parenting/child wellbeing/health economics) and uptake/attrition/completion rates. We conducted qualitative interviews with BCT parents (n=26), other parents in receipt of OST (n=11), BCT therapists (n=6) and five focus groups with referring staff (n=24) to explore acceptability and barriers/facilitators to implementation.

Profile of the couples 13 couples (out of 28 referred) Concordant=7, Discordant=6 OST (13 male, 7 female) Years on OST: Range 5-29yrs; Mean 14yrs Ages: 25-45yrs old; Mean 35yrs Married=2; Co-habiting=9; Living apart=2 Length of relationship: 5-20yrs (Mean 11yrs) Children living with parents=17 6 couples had 11 children living elsewhere Age of youngest child: 3mths – 14yrs (Mean 5yrs) Multiple and complex needs!

Is it feasible? Patient level Clinician level Structural level Child protection agenda Whole family approach not embedded Service redesign/budget cuts/morale Cultural ‘fit’ Assessment & signposting Optional (‘Opt-in’) intervention Accessibility/acceptability ‘Fit’ with model of care and other intervention approaches Operational issues to overcome Gatekeeping Lack of buy-in Caseloads, Targets, Staffing Confidence/knowledge Individual vs family-focused practice Child Care, Transport, Money, Time Reluctance to see ‘another’ professional Resistance to drug testing Daily contract ‘cheesy’ or irrelevant Patient level Clinician level Structural level Service level Results: 13/18 couples enrolled (June 2016-June 2017) but only seven engaged in the intervention and none completed the programme. Average number of sessions attended was 3.4/12. Barriers to implementation were multiple and inter-related. Parent-level, clinician, service, operational, and structural-level obstacles to recruitment, engagement, retention and delivery of BCT.

For discussion - next steps? Can BCT be adapted to become a realistic option for parents with children? Can professionals and individual services adapt to make BCT a realistic option? Can structural barriers be overcome to make BCT a realistic option? Can BCT be adapted to become a realistic option for parents with children? Potentially yes – shorter number of sessions, more flexible delivery, individually tailored/reviewed, wider family involvement Can professionals and individual services adapt to make BCT a realistic option? Potentially yes – shift in mind set/culture, routine treatment, accessible, training/support/supervision Can structural barriers be overcome to make BCT a realistic option? Potentially yes – whole family approach, adult/child services join working, child care/incentives, family support not child protection focus.