English summary: IS THE TREATMENT OF SUBSTANCE ABUSING MOTHERS AND THEIR BABIES WORTHWHILE?

Background A residential treatment model has been developed in Finland, which is specifically designed for substance abusing pregnant and parenting women, and is focussed on supporting both maternal abstinence from substances and the mother-baby relationship. The aim of this study was to explore factors related to individual differences in treatment outcome.

Methods 34 mother-baby pairs from three of these treatment units were assessed during the pre- to postnatal period. The methods included self-report questionnaires for maternal psychiatric symptoms and trauma (EPDS, BSI, IIP, TAQ), video assessment of early interaction (CI), semistructured interviews for maternal mentalising/reflective functioning capacity (PI, PDI) and clinical child development assessment (BSIDII). Assessment time points were during pregnancy, at 1, 3, and 4 months postpartum, and at 1 and 2 years of the child's age as follow-up.

Results The quality of maternal interaction and maternal mentalising capacity were on average weak, but with rather wide individual variation. Concern regarding child development scores arose towards the two-year follow-up point. The type of maternal postnatal psychiatric symptomatology and the level of maternal mentalising capacity seemed to be associated with later outcome in terms of maternal relapse to substance abuse and need for alternative child care.

Conclusions In designing treatment and follow-up of these mother-baby pairs, more careful attention should be paid to early identification and type of maternal psychiatric symptoms and mothers' expressions of subjectively experienced difficulties in early care of the baby. The mentalising (reflective functioning) approach seems to be an important means of enhancing the effectiveness of the interventions with these mother-baby pairs.

Kiitokset: National Institute of Drug Abuse (NIDA/NIH), Suomen Lääketieteen Säätiö, Suomen Kulttuurirahasto, Lapsen Aika -säätiö