Temperamental and physiological regulatory capacity in infancy: Links with toddler behavior problems.

Although correlates of temperamental regulatory processes in childhood have been well established, there is considerably less work examining correlates and moderators of rudimentary forms of temperamental regulation in infancy. We examined whether infants' physiological regulation indexed via changes in respiratory sinus arrhythmia (RSA) across phases of the Still-Face Paradigm moderated the association between maternal-reported infant regulatory capacity at 8 months (N = 50, Mage = 8.51 months, SDage = 0.28 months, 25 girls) and behavior problems at 14 months. We found that cardiac vagal regulation from baseline to still-face moderated the relation between infant regulatory capacity at 8 months and behavior problems at 14 months. Among infants who displayed relatively high cardiac vagal regulation from baseline to still-face, regulatory capacity was negatively associated with behavior problems. There was no relation between regulatory capacity and behavior problems among infants who displayed average or relatively low cardiac vagal regulation. We speculate that high levels of regulatory capacity and cardiac vagal regulation may allow infants to focus their attention outward and cope with emotionally evocative environmental demands as they arise even in the absence of external regulation provided by their caregivers.

Young mothers' use of and experiences with mental health care services in Ontario, Canada: a qualitative descriptive study.

BACKGROUND: Despite the high prevalence of mental health issues among young mothers, their subsequent needs for mental health care support does not correlate with their access and use of services. The purpose of this study, grounded in the experiences of young mothers living in Ontario, Canada, was to describe their experiences of using mental health services during the perinatal period, and to identify the attributes of services and professionals that influenced their decision to engage with mental health services. METHODS: As the qualitative component of a sequential explanatory mixed methods study, the principles of qualitative description informed sampling, data collection, and analysis decisions. In-depth, semi-structured interviews were conducted with a purposeful sample of 29 young mothers (≤ 21 years) who met diagnostic criteria for at least one psychiatric disorder, and who were ≥ 2 months postpartum. Interview data were triangulated with data from ecomaps and a sub-set of demographic data for this purposeful sample from the survey conducted in the quantitative study component. Qualitative data were analyzed using both conventional content analysis and reflexive thematic analysis; the subset of survey data extracted for these 29 participants were analyzed using descriptive statistics. RESULTS: Young mothers identified the need to have at least one individual, either an informal social support or formal service provider who they could talk to about their mental health. Among participants deciding to seek professional mental health support, their hesitancy to access services was grounded in past negative experiences or fears of being judged, being medicated, not being seen as an active partner in care decisions or experiencing increased child protection involvement. Participants identified organizational and provider attributes of those delivering mental health care that they perceived influenced their use of or engagement with services. CONCLUSION: Organizations or health/social care professionals providing mental health services to young pregnant or parenting mothers are recommended to implement trauma-and violence-informed care. This approach prioritizes the emotional and physical safety of individuals within the care environment. Applying this lens in service delivery also aligns with the needs of young mothers, including that they are actively listened to, treated with respect, and genuinely engaged as active partners in making decisions about their care and treatment.

Assessing fidelity to family-based treatment: an exploratory examination of expert, therapist, parent, and peer ratings.

INTRODUCTION: Fidelity is an essential component for evaluating the clinical and implementation outcomes related to delivery of evidence-based practices (EBPs). Effective measurement of fidelity requires clinical buy-in, and as such, requires a process that is not burdensome for clinicians and managers. As part of a larger implementation study, we examined fidelity to Family-Based Treatment (FBT) measured by several different raters including an expert, a peer, therapists themselves, and parents, with a goal of determining a pragmatic, reliable and efficient method to capture treatment fidelity to FBT. METHODS: Each therapist audio-recorded at least one FBT case and submitted recordings from session 1, 2, and 3 from phase 1, plus one additional session from phase 1, two sessions from phase 2, and one session from phase 3. These submitted files were rated by an expert and a peer rater using a validated FBT fidelity measure. As well, therapists and parents rated fidelity immediately following each session and submitted ratings to the research team. Inter-observer reliability was calculated for each item using the intraclass correlation coefficient (ICC), comparing the expert ratings to ratings from each of the other raters (parents, therapists, and peer). Mean scale scores were compared using repeated measures ANOVA. RESULTS: Intraclass correlation coefficients revealed that agreement was the best between expert and peer, with excellent, good, or fair agreement in 7 of 13 items from session 1, 2 and 3. There were only four such values when comparing expert to parent agreement, and two such values comparing expert to therapist ratings. The rest of the ICC values indicated poor agreement. Scale level analysis indicated that expert fidelity ratings for phase 1 treatment sessions scores were significantly higher than the peer ratings and, that parent fidelity ratings tended to be significantly higher than the other raters across all three treatment phases. There were no significant differences between expert and therapist mean scores. CONCLUSIONS: There may be challenges inherent in parents rating fidelity accurately. Peer rating or therapist self-rating may be considered pragmatic, efficient, and reliable approaches to fidelity assessment for real-world clinical settings.

Family-based treatment for children and adolescents with eating disorders: a mixed-methods evaluation of a blended evidence-based implementation approach.

In this study, we evaluated a blended implementation approach with teams learning to provide family-based treatment (FBT) to adolescents with eating disorders. Four sites participated in a sequential mixed method pre-post study to evaluate the implementation of FBT in their clinical settings. The implementation approach included: (a) preparatory site visits; (b) the establishment of implementation teams; (c) a training workshop; (d) monthly clinical consultation; (e) monthly implementation consultation; and (f) fidelity assessment. Quantitative measures examining attitudes toward evidence-based practice, organizational learning environment and organizational readiness for change, as well as, individual readiness for change were delivered pre- and postimplementation. Correlational analyses were used to examine associations between baseline variables and therapist fidelity to FBT. Fundamental qualitative description guided the sampling and data collection for the qualitative interviews performed at the conclusion of the study. Seventeen individuals participated in this study (nine therapists, four medical practitioners, and four administrators). The predetermined threshold of implementation success of 80% fidelity in every FBT session was achieved by only one therapist. However, mean fidelity scores were similar to those reported in other studies. Participant attitudes, readiness, and self-efficacy were not associated with fidelity and did not change significantly from pre- to postimplementation. In qualitative interviews, all participants reported that the implementation intervention was helpful in adopting FBT. Our blended implementation approach was well received by participants. A larger trial is needed to determine which implementation factors predict FBT fidelity and impact patient outcomes.

The Mental Health of Young Canadian Mothers.

PURPOSE: Although many young mothers (aged <21 years) are exposed to multiple adversities that increase their risk for mental illness, prevalence data are largely limited self-report questionnaires estimating only the prevalence of postpartum depression. Gaining a greater understanding of the burden of a broader range of common mental illnesses affecting these young women has the potential to improve their health as well as the development and functioning of their children. METHODS: The Young Mothers Health Study recruited 450 mothers aged <21 years and 100 comparison mothers (aged >20 years old at first delivery) living in urban and rural central-west Ontario. Age-matched young mothers were also compared with 15- to 17-year-old women without children (N = 630) from the 2014 Ontario Child Health Study. The prevalence of current mental disorders was assessed using the Mini-International Neuropsychiatric Interview for Children and Adolescents. RESULTS: Nearly 2 of 3 young mothers reported at least one mental health problem, and almost 40% had more than one. Young mothers were 2 to 4 times as likely to have an anxiety disorder (generalized anxiety disorder, separation anxiety disorder, social phobia, and specific phobia), attention-deficit/hyperactivity disorder, oppositional defiant disorder, or conduct disorder and were 2 to 4 times more likely to have more than one psychiatric problem than older comparison mothers or women aged 15-17 years. CONCLUSIONS: Given the high rates of mental health problems and complex needs of young mothers in Canada and the possible adverse effects of maternal psychopathology on their children, further efforts should be directed at engaging and treating this high-risk group.

Parenting Interventions for Mothers With Problematic Substance Use: A Systematic Review of Research and Community Practice.

Women with problematic substance use are frequently referred to interventions to promote positive parenting. Parenting interventions that attend to the unique risks faced by this population may enhance engagement and outcomes. While reviews of extant parenting interventions in the research literature have been undertaken, no studies have examined parenting interventions being implemented in community practice and the extent to which these are informed by current research. We systematically compared parenting interventions offered in 12 maternal substance use treatment programs in one Canadian province with those described in the research literature (K = 21). Few parenting interventions were replicated, either within or across the two samples. However, parenting interventions within both samples were largely similar in their objectives. Across both research and community samples, approximately half of the interventions were developed or adapted for a problematic substance use population. Parenting knowledge, psychosocial risk, and maternal emotional regulation were most commonly addressed. Risks pertaining to the impact of drug craving and substance-related changes in neurobiology associted with parenting were less commonly addressed. Findings highlight current strengths and limitations of parenting interventions within research and community settings, with recommendations offered for future research and knowledge translation.

The children of preterm survivors: shyness, parenting, and parental stress.

Extremely low birth weight (ELBW) survivors have higher rates of shyness, a risk factor for poorer outcomes across the life span. Due to advances in fetal and neonatal medicine, the first generation of ELBW survivors have survived to adulthood and become parents. However, no studies have investigated the transmission of their stress vulnerability to their offspring. We explored this phenomenon using a population-based cohort of ELBW survivors and normal birth weight (NBW) controls. Using data from three generations, we examined whether the shyness and parenting stress of ELBW and NBW participants (Generation 2) mediated the relation between the parenting style of their parents (Generation 1) and shyness in their offspring (Generation 3), and the extent to which exposure to perinatal adversity (Generation 2) moderated this mediating effect. We found that among ELBW survivors, parenting stress (in Generation 2) mediated the relation between overprotective parenting style in Generation 1 (grandparents) and child shyness in Generation 3. These findings suggest that perinatal adversity and stress may be transmitted to the next generation in humans, as reflected in their perceptions of their children as shy and socially anxious, a personality phenotype that may subsequently place their children at risk of later mental and physical health problems.

Themes arising during implementation consultation with teams applying family-based treatment: a qualitative study.

BACKGROUND: This study describes themes arising during implementation consultation with teams providing Family-Based Treatment (FBT) to adolescents with eating disorders. METHODS: Participants were implementation teams (one lead therapist, one medical practitioner and one administrator) at four sites. These teams agreed to support the implementation of FBT, and participated in monthly consultation calls which were audio-recorded, transcribed verbatim and coded for themes. Twenty percent of the transcripts were double-coded to ensure consistency. Fundamental qualitative description guided the sampling and data collection. RESULTS: Twenty-five (average per site = 6) transcripts were coded using thematic content analysis. Six major themes emerged: 1) system barriers and facilitators 2) the role of the medical practitioner, 3) research implementation, 4) appropriate cases, 5) communication, and 6) program impact. CONCLUSIONS: Implementation themes aligned with previous research examining the adoption of FBT, and provide additional insight for clinical programs seeking to implement FBT, emphasizing the importance of role clarity, and team communication.

Using a Discrete Choice Conjoint Experiment to Engage Stakeholders in the Design of an Outpatient Children's Health Center.

OBJECTIVES: To engage users in the design of a regional child and youth health center. BACKGROUND: The perspective of users should be an integral component of a patient-centered, evidence-based approach to the design of health facilities. METHODS: We conducted a discrete choice conjoint experiment (DCE), a method from marketing research and health economics, as a component of a strategy to engage users in the preconstruction planning process. A sample of 467 participants (290 staff and 177 clients or community stakeholders) completed the DCE. RESULTS: Latent class analysis identified three segments with different design preferences. A group we termed an enhanced design (57%) segment preferred a fully featured facility with personal contacts at the start of visits (in-person check-in, personal waiting room notification, volunteer-assisted wayfinding, and visible security), a family resource center with a health librarian, and an outdoor playground equipped with covered heated pathways. The self-guided design segment (11%), in contrast, preferred a design allowing a more independent use of the facility (e.g., self-check-in at computer kiosks, color-coded wayfinding, and a self-guided family resource center). Designs affording privacy and personal contact with staff were important to the private design segment (32%). The theme and decor of the building was less important than interactive features and personal contacts. CONCLUSION: A DCE allowed us to engage users in the planning process by estimating the value of individual design elements, identifying segments with differing views, informing decisions regarding design trade-offs, and simulating user response to design options.

THE WORKING MODEL OF THE CHILD INTERVIEW: STABILITY OF THE DISRUPTED CLASSIFICATION IN A COMMUNITY INTERVENTION SAMPLE.

The Working Model of the Child Interview (WMCI; C.H. Zeanah, D. Benoit, & M.L.Barton, 1986) assesses caregiver internal representation of his or her child and the relationship with the child, with a relatively new coding system for representations associated with disorganized attachment-WMCI-Disrupted (WMCI-D; A. Crawford & D. Benoit, 2009). In the present study, we investigated the stability of the WMCI-D classification using a sample of 62 mothers who completed the WMCI twice as part of their involvement in a randomized trial comparing an attachment-focused parent group to home visiting. Demographic information and measures of maternal sensitivity, parenting stress, and infant attachment also were obtained in the randomized trial. There was significant concordance between WMCI-D classifications over 8 months (from pretest to follow-up) (90% agreement; κ = .79), with 61% of mothers remaining disrupted, 29% remaining not-disrupted, 8% becoming disrupted, and 2% becoming not-disrupted. Compared to mothers with not-disrupted representations, mothers classified as disrupted had lower socioeconomic status, more parenting stress, and infants with less attachment security, ps < .05. These results suggest that the WMCI-D classification is stable over 8 months during infancy. The findings are consistent with research demonstrating stability for disorganized/unresolved/disrupted classifications, the validity of the WMCI-D classification, and the lack of intervention impact on disorganized attachment.

Implementing highly specialized and evidence-based pediatric eating disorder treatment: protocol for a mixed methods evaluation.

BACKGROUND: Eating disorders, which include anorexia nervosa and bulimia nervosa, are common in adolescent females and can have serious emotional and physical consequences, including death. Despite our knowledge about the severity of these illnesses, previous research indicates that adolescent patients are not receiving the best available treatment with fidelity. The main goal of this project is to reduce the knowledge gap between what research indicates is the best known treatment and what is actually delivered in clinical practice. Informed by the National Implementation Research Network model and the Consolidated Framework for Implementation Research meta-theory, our primary study aim is to increase the capacity of Ontario-based therapists to provide family-based treatment, by providing training and ongoing supervision. METHODS/DESIGN: We will use a multi-site case study with a mixed method pre/post design to examine several implementation outcomes across four eating disorder treatment programs. We will provide a training workshop on family-based treatment as well as ongoing monthly supervision. In addition, we will assemble implementation teams at each site and coach them by phone on a monthly basis regarding any process issues. Our main outcomes include fidelity to the treatment model using quantitative evaluation of audio-recorded therapy sessions, as well as qualitative analysis of the perceptions of the implementation process using audio-recorded focus groups with all clinicians and administrators involved in the study. DISCUSSION: To our knowledge, this is the first study to evaluate an implementation strategy for an evidence-based treatment for eating disorders. Challenges to date include obtaining ethics approval at all sites, and recruitment. This research will help to inform future studies on how to best implement evidence-based treatments in this field.

Predictors of research use among staff in aboriginal addiction treatment programs serving women.

The objective of this study was to identify the predictors of research use among staff from Aboriginal addiction programs serving women. A total of 89 staff from 26 Aboriginal addiction programs completed an online survey that included items assessing the theory of planned behavior constructs (attitudes, subjective norms, perceived behavioral control), intent to use research, and research use. Consistent with the theory of planned behavior, research use was predicted by attitudes, subjective norms, and perceived behavioral control. Intent to use research was not a mediator, demonstrating partial applicability of the theory of planned behavior to staff in Aboriginal addiction programs serving women.

Implementing stakeholder-informed research in the substance abuse treatment sector: strategies used by Connections, a Canadian knowledge translation and exchange project.

BACKGROUND: Researcher-stakeholder collaboration has been identified as critical to bridging research and health system change. While collaboration models vary, meaningful stakeholder involvement over time ("integrated knowledge translation") is advocated to improve the relevance of research to knowledge users. This short report describes the integrated knowledge translation efforts of Connections, a knowledge translation and exchange project to improve services for women with substance abuse problems and their children, and implementation barriers and facilitators. FINDINGS: Strategies of varying intensities were used to engage diverse stakeholders, including policy makers and people with lived experience, and executive directors, program managers, and service providers from Canadian addiction agencies serving women. Barriers to participation included individual (e.g., interest), organizational (e.g., funding), and system level (e.g., lack of centralized stakeholder database) barriers. Similarly, facilitators included individual (e.g., perceived relevance) and organizational (e.g., support) facilitators, as well as initiative characteristics (e.g., multiple involvement opportunities). Despite barriers, Connections' stakeholder-informed research efforts proved essential for developing clinically relevant and feasible processes, measures, and implementation strategies. CONCLUSIONS: Stakeholder-researcher collaboration is possible and robust integrated knowledge translation efforts can be productive. Future work should emphasize developing and evaluating a range of strategies to address stakeholders' knowledge translation needs and to facilitate sustained and meaningful involvement in research.

Using a knowledge transfer framework to identify factors facilitating implementation of family-based treatment.

OBJECTIVE: To conduct a qualitative study to identify factors that would facilitate the transfer of the research evidence on Family-Based Treatment (FBT) into clinical practice. METHOD: Fundamental qualitative description guided sampling, data collection, and analytic decisions for this study. Forty therapists who treat children and adolescents under the age of 18 with Anorexia Nervosa (AN) and belong to Ontario's provincial network of specialized eating disorder services completed an in-depth interview focusing on elements proposed by the Lavis knowledge transfer framework. An experienced coder conducted content analysis, with 20% of the interviews double-coded for reliability purposes. RESULTS: Participants requested training in the FBT model, including the provision of research evidence (i.e., journal articles), as well as the specific tenets of the model according to the FBT manual. The suggested audience for implementation included not only therapists themselves, but administrators, physicians, and community members. The development of best practice guidelines was also supported. Local FBT experts were suggested as credible messengers. Infrastructure relating to financial support and time away from clinical duties were reported to be essential for training. Ongoing supervision and mentorship were reported to be important elements of implementation and evaluation processes. DISCUSSION: Suggestions for moving FBT into practice were consistent with previous research, however, the importance of obtaining the evidence in the form of primary research articles and obtaining team buy-in were remarkable. Developing context-specific training programs and administrative processes for the implementation of FBT are warranted.

Decision-making processes for the uptake and implementation of family-based therapy by eating disorder treatment teams: a qualitative study.

OBJECTIVE: To explore the decision-making processes involved in the uptake and implementation of evidence-based treatments (EBTs), namely, family-based treatment (FBT), among therapists and their administrators within publically funded eating disorder treatment programs in Ontario, Canada. METHOD: Fundamental qualitative description guided sampling, data collection, and analytic decisions. Forty therapists and 11 administrators belonging to a network of clinicians treating eating disorders completed an in-depth interview regarding the decision-making processes involved in EBT uptake and implementation within their organizations. Content analysis and the constant comparative technique were used to analyze interview transcripts, with 20% of the data independently double-coded by a second coder. RESULTS: Therapists and their administrators identified the importance of an inclusive change culture in evidence-based practice (EBP) decision-making. Each group indicated reluctance to make EBP decisions in isolation from the other. Additionally, participants identified seven stages of decision-making involved in EBT adoption, beginning with exposure to the EBT model and ending with evaluating the impact of the EBT on patient outcomes. Support for a stage-based decision-making process was in participants' indication that the stages were needed to demonstrate that they considered the costs and benefits of making a practice change. Participants indicated that EBTs endorsed by the Provincial Network for Eating Disorders or the Academy for Eating Disorders would more likely be adopted. DISCUSSION: Future work should focus on integrating the important decision-making processes identified in this study with known implementation models to increase the use of low-cost and effective treatments, such as FBT, within eating disorder treatment programs.

Partnerships Among Canadian Agencies Serving Women with Substance Abuse Issues and Their Children.

Women with substance use issues and their children have unique needs that are best met through collaborative and coordinated service delivery offered by a variety of agencies. However, in Canada and elsewhere, services tend to be fragmented and fail to address children's needs. This study aimed to describe the partnership patterns, activities, and qualities among Canadian agencies serving women with addictions and to determine predictors of partnerships. We found that a number of partnerships exist, and that the extent and characteristics of these partnerships vary. Agency responsiveness to clients was predictive of sending referrals whereas friendliness predicted joint programming and consultation. Four central agencies played key linkage roles. Efforts should be made to build on the social capital inherent in these agencies to strengthen existing networks, further develop linkages to improve service delivery, and promote evidence-informed practice in a field where there is an identified research-practice gap.

Maternal pre-pregnancy body mass index and offspring temperament and behavior at 1 and 2 years of age.

Recent research suggests that fetal exposure to increased maternal body mass index (BMI) during pregnancy may be associated with psychopathology later in life. When this link first emerges, and if it is due to intrauterine exposures or confounding variables is not known. We therefore assessed associations between maternal pre-pregnancy BMI and: (1) temperament at 1 year of age, and (2) Child Behavior Checklist internalizing and externalizing scales at age 2 in the 2900 mothers and infants enrolled in the Western Australian Pregnancy Study. Pre-pregnancy BMI was positively associated with externalizing scores (ß = 0.131, 95 % CI 0.013-0.249) at age 2, even after adjustment for confounders, but not with internalizing scores or an increased risk of difficult temperament. These data suggest that fetal exposure to increased maternal BMI is associated with elevated levels of behavior problems as early as age 2, and that this may be linked to the intrauterine environment.

Understanding the uptake of family-based treatment for adolescents with anorexia nervosa: therapist perspectives.

OBJECTIVE: To explore and describe therapists' perceptions of the factors affecting their uptake of family-based treatment (FBT) for adolescents with anorexia nervosa (AN). METHOD: Fundamental qualitative description guided the sampling and data collection in this study. A purposeful sample of 40 therapists providing treatment to youth with AN, completed an in-depth interview. Conventional content analysis guided the development of initial codes and categories, whereas constant comparison analytic techniques were used to compare and contrast therapist perceptions across contexts. Summative content analysis was used to provide counts of keywords, phrases, and themes. RESULTS: Therapists face several barriers to the implementation of FBT, divided broadly into interventional, organizational, interpersonal, patient/family, systemic, and illness factors. Therapists support the implementation of evidence-based practices, including FBT for AN, but fidelity to this model is not practiced. Specific concerns about the intervention included weighing the patient, providing nutritional advice, and the family meal. Ninety-five percent of therapists requested further training in the FBT model. DISCUSSION: Further investigation into the barriers and facilitating factors to the use of FBT is warranted. Understanding effective dissemination and training strategies is critical to ensuring patients receive the best possible care.

Reporting of feasibility factors in publications on integrated treatment programs for women with substance abuse issues and their children: a systematic review and analysis.

BACKGROUND: Implementation of evidence-based practices in real-world settings is a complex process impacted by many factors, including intervention, dissemination, service provider, and organizational characteristics. Efforts to improve knowledge translation have resulted in greater attention to these factors. Researcher attention to the applicability of findings to applied settings also has increased. Much less attention, however, has been paid to intervention feasibility, an issue important to applied settings. METHODS: In a systematic review of 121 documents regarding integrated treatment programs for women with substance abuse issues and their children, we examined the presence of feasibility-related information. Specifically, we analysed study descriptions for information regarding feasibility factors in six domains (intervention, practitioner, client, service delivery, organizational, and service system). RESULTS: On average, fewer than half of the 25 feasibility details assessed were included in the documents. Most documents included some information describing the participating clients, the services offered as part of the intervention, the location of services, and the expected length of stay or number of sessions. Only approximately half of the documents included specific information about the treatment model. Few documents indicated whether the intervention was manualized or whether the intervention was preceded by a standardized screening or assessment process. Very few provided information about the core intervention features versus the features open to local adaptation, or the staff experience or training required to deliver the intervention. CONCLUSIONS: As has been found in reviews of intervention studies in other fields, our findings revealed that most documents provide some client and intervention information, but few documents provided sufficient information to fully evaluate feasibility. We consider possible explanations for the paucity of feasibility information and provide suggestions for better reporting to promote diffusion of evidence-based practices.

Integrated programs for mothers with substance abuse issues and their children: a systematic review of studies reporting on child outcomes.

BACKGROUND: Integrated treatment programs (those that include on-site pregnancy-, parenting-, or child-related services with addiction services) were developed to break the intergenerational cycle of addiction, potential child maltreatment, and poor outcomes for children. OBJECTIVES: To examine the impact and effects of integrated programs for women with substance abuse issues and their children, we performed a systematic review of studies published from 1990 to 2011. METHODS: Literature search strategies included online bibliographic database searches, checking printed sources, and requests to researchers. Studies were included if all participants were mothers with substance abuse problems at baseline; the treatment program included at least 1 specific substance use treatment and at least 1 parenting or child treatment service; the study design was randomized, quasi-experimental, or cohort; and there were quantitative data on child outcomes. We summarized data on child development, growth, and emotional and behavioral outcomes. RESULTS: Thirteen studies (2 randomized trials, 3 quasi-experimental studies, 8 cohort studies; N=775 children) were included in the review. Most studies using pre-post design indicated improvements in child development (with small to large effects, ds=0.007-1.132) and emotional and behavioral functioning (with most available effect sizes being large, ds=0.652-1.132). Comparison group studies revealed higher scores for infants of women in integrated programs than those not in treatment, with regard to development and most growth parameters (length, weight, and head circumference; with all available effect sizes being large, ds=1.16-2.48). In studies comparing integrated to non-integrated programs, most improvements in emotional and behavioral functioning favored integrated programs and, where available, most effect sizes indicated that this advantage was small (ds=0.22-0.45). CONCLUSIONS: Available evidence supports integrated programs, as findings suggest that they are associated with improvements in child development, growth, and emotional and behavioral functioning. More research is required comparing integrated to non-integrated programs. This review highlights the need for improved methodology, study quality, and reporting to improve our understanding of how best to meet the needs of children of women with substance abuse issues.