Abstract
BackgroundMillions of children across North America and Europe live in families with alcohol or drug abusing parents. These children are at risk for a number of negative social, emotional and developmental outcomes, including an increased likelihood of developing a substance use disorder later in life. Family-based intervention programs for children with substance abusing parents can yield positive outcomes. This study is a realist review of evaluations of family-based interventions aimed at improving psychosocial outcomes for children of substance abusing parents (COSAPs). The primary objectives were to uncover patterns of contextual factors and mechanisms that generate program outcomes, and advance program theory in this field.MethodsRealist review methodology was chosen as the most appropriate method of systematic review because it is a theory-driven approach that seeks to explore mechanisms underlying program effectiveness (or lack thereof). A systematic and comprehensive search of academic and grey literature uncovered 32 documents spanning 7 different intervention programs. Data was extracted from the included documents using abstraction templates designed to code for contexts, mechanisms and outcomes of each program. Two candidate program theories of family addiction were used to guide data analysis: the family disease model and the family prevention model. Data analysis was undertaken by a research team using an iterative process of comparison and checking with original documents to determine patterns within the data.ResultsPrograms originating in both the family disease model and the family prevention model were uncovered, along with hybrid programs that successfully included components from each candidate program theory. Four demi-regularities were found to account for the effectiveness of programs included in this review: (1) opportunities for positive parent-child interactions, (2) supportive peer-to-peer relationships, (3) the power of knowledge, and (4) engaging hard to reach families using strategies that are responsive to socio-economic needs and matching services to client lived experience.ConclusionsThis review yielded new findings that had not otherwise been explored in COSAP program research and are discussed in order to help expand program theory. Implications for practice and evaluation are further discussed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0158-4) contains supplementary material, which is available to authorized users.
Highlights
Millions of children across North America and Europe live in families with alcohol or drug abusing parents
The current study sought to fill this gap by adopting a theory-focused approach to improve understanding family-based interventions for children of substance abusing parents (COSAPs). This realist review focused on the following key research questions: What patterns of contextual factors and mechanisms can be identified, and how do they generate outcomes? Can a COSAP program theory be articulated and refined, and if so, what are the implications for program implementation? A theory-building approach was used to guide to this realist review
Throughout the search process, it became evident that relatively few COSAP programs existed that met the review criteria; multiple documents were found as sources of evidence to support each program
Summary
Millions of children across North America and Europe live in families with alcohol or drug abusing parents. These children are at risk for a number of negative social, emotional and developmental outcomes, including an increased likelihood of developing a substance use disorder later in life. This study is a realist review of evaluations of family-based interventions aimed at improving psychosocial outcomes for children of substance abusing parents (COSAPs). Children of substance abusing parents (COSAPs) are at increased risk of negative psychosocial and developmental outcomes such as depression, anxiety, social isolation, conduct and behavioural problems and lower academic achievement [7,8,9]
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