Promoting positive parenting for mothers with OUD: Implementation of a video-coaching intervention in pediatrics

PROJECT SUMMARY/ABSTRACT The US opioid epidemic is a public health emergency with devastating intergenerational impacts. Children with in-utero exposure to opioids are at high risk for emotional and behavioral difficulties as well as increased risk of substance misuse in adolescence and adulthood. Parenting behaviors represent a modifiable factor in this risk pathway. Maternal opioid use disorder (OUD) increases risk for maladaptive parenting behaviors associated with long-term child behavioral and mental health problems. There is increasing evidence that parenting interventions for mothers with OUD improve parenting behaviors and reduce child behavior problems. Research has also shown benefits of parenting interventions for maternal psychosocial functioning, including reduction of relapse risk. Despite promise, existing parenting interventions for mothers with OUD have been limited in terms of accessibility and uptake. There is an urgent need to make empirically supported preventive parenting interventions acceptable and readily available to support dyads affected by OUD, especially during the preschool period when behavior problems linked to poor adult mental health often first manifest. A parent- child interaction therapy-based prevention model entitled THRIVE offers a brief, accessible video coaching strategy to promote responsive parenting for mothers with OUD. THRIVE is a uniquely promising approach to meet the needs of mothers with OUD because THRIVE includes emotion coaching, which has been shown to improve caregiver emotion regulation, a critical intervention target for mothers with OUD. Integration of THRIVE into pediatric primary care is a promising, scalable model for engaging mothers in a non-stigmatizing setting and increasing access through use of telehealth. The goals of this K23 are therefore to test the effectiveness of this intervention among mothers with OUD and their preschool children and to tailor implementation for this population in the pediatric primary care setting. Aim 1 will use quantitative and qualitative methods to identify facilitators and barriers to implementation in this new context for this population, guided by the Consolidated Framework for Implementation Research. Aim 2 will engage primary care staff and mothers with OUD in implementation blueprinting - a participatory process to address identified implementation barriers and build a tailored implementation package. Aim 3 will be a pilot trial to test both implementation and effectiveness outcomes. To achieve the proposed goals, I require training in evidence-based maternal substance use disorder treatment, implementation blueprinting, and design and conduct of clinical prevention trials. I will acquire these skills and conduct the proposed research at Boston Medical Center, the largest safety net hospital in New England and national leader in the care of individuals with OUD. At the end of the K23 award period, I will be well-positioned to accomplish my long-term goal to become an independent investigator with expertise in testing and implementing parenting interventions to prevent negative outcomes for mothers with OUD and their children.