Dyadic Intervention for Families Affected By Opioid Use Disorder: Qualitative Insights on Mechanisms of Change

Background and Purpose: Maternal substance misuse during the perinatal period is associated with risks for children's cognitive, social, and emotional development. While many caregivers with opioid use disorder/substance use disorder (OUD/SUD) enter recovery during this period, they often face significant trauma histories, mental health challenges, and low social support that can result in difficulties with emotion regulation and infant attunement. These intersecting individual-level stressors combine with structural and societal forces (e.g. criminalization, stigma, socioeconomic adversity, limited access to treatment and resources, and racialized inequities) to create substantial barriers to recovery and parenting. Under these conditions, parenting difficulties often emerge that strain the parent-child relationship and undermine early child development. In response to these challenges, a few social work interventions for mothers with OUD/SUD and their young children seek to support maternal reflective functioning and mental health, mother-child interactions, and child socio-emotional development in the context of broader family stressors. While studies of these interventions demonstrate positive impacts on caregiving behaviors and dyadic outcomes, participant experiences are understudied. In this study, we seek to understand caregiver perceptions of BRIGHT, a perinatal parenting intervention delivered by social workers to mothers with OUD from pregnancy through six months postpartum.

Methods: Semi-structured interviews were conducted with 19 mothers (M age= 30 years; 63% white, non-Hispanic; 52% income < $10,000) enrolled in a pragmatic randomized control trial of BRIGHT delivered at a perinatal clinic for people with OUD in an urban safety net hospital. Interviews examined participants’ experiences, including clinician relationships, perceived benefits, and impacts on parenting. Using thematic analysis techniques, two coders developed a codebook and completed line-by-line coding of transcripts, followed by the identification of key themes.

Results: Despite initial ambivalence, most mothers reported strong relationships with the BRIGHT clinician characterized by trust, non-judgmental listening, flexibility, and responsiveness, in contrast to prior personal and provider relationships. Within the therapeutic alliance, mothers emphasized the value of having a safe space to reflect and regulate emotions, validation and insights that enhanced parenting confidence, and navigational support for resources and child welfare involvement. Mothers had mixed perceptions about parent-infant relationship changes, yet many felt that supports offered through BRIGHT contributed positively to parenting capacities and expressed a desire for continued participation.

Conclusions and Implications: Qualitative findings indicate that the BRIGHT perinatal parenting intervention was favorable and beneficial to new mothers with OUD navigating the uncertainties and stressors of early parenting and recovery. Participants’ accounts suggest that certain intervention components, such as the focus on emotion regulation, reflective functioning, and concrete supports may be particularly salient when BRIGHT is introduced during the prenatal period. This qualitative study centers the lived experience of participants to elucidate mechanisms and actionable components that can guide future implementation and advocacy efforts in perinatal social work practice for families impacted by SUD/OUD. Conducted in close partnership with a perinatal clinic, this research forged a strong and enduring social work-medical care collaboration that has engendered new convergent research seeking to elevate mothers’ voices and address health disparities facing this population.