Helping drug dependent parents and their children Is

A feasibility study Behavioural Couples Therapy (BCT) as an adjunct to opioid substitution therapy

Is it feasible? • Gatekeeping • Lack of buy-in • Caseloads, Targets, Staffing •

For discussion - next steps? • Can BCT be adapted to become a realistic

Slides: 5

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

A feasibility study Behavioural Couples Therapy (BCT) as an adjunct to opioid substitution therapy for drug dependent parents Ø The intervention Ø Study design Ø Mixed methods Ø Baseline data Ø End-of-treatment data Ø Qualitative interviews Ø Ø Couples Other parents Therapists Referrers

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

Is it feasible? • 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 • Assessment & signposting • Optional (‘Opt-in’) intervention • Accessibility/acceptability • ‘Fit’ with model of care and other intervention approaches • Operational issues to overcome Patient level Clinician level Service level Structural level • Child protection agenda • Whole family approach not embedded • Service redesign/budget cuts/morale • Cultural ‘fit’

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?