Abstract
OBJECTIVE: Elicit the perspectives of mothers with substance use disorder (SUD) on child well-being and parental substance use.
METHODS: We conducted semistructured focus groups of mothers with SUD on parenting, child well-being, naloxone, and experiences with medical care and Child Protective Services (CPS). Focus group transcripts were iteratively reviewed to generate a codebook, which was applied in NVivo by 2 independent coders. We used inductive thematic analysis to examine codes relevant to child well-being, harm reduction, and clinician reporting to CPS.
RESULTS: Twenty-three women participated in 5 focus groups. Four themes emerged: 1) mothers felt their substance use negatively impacted their ability to provide attentive supervision and emotional support; 2) mothers discussed strategies to minimize harm to children but had limited familiarity with naloxone use for unintentional ingestions; 3) mothers viewed child well-being as a spectrum but felt that clinicians often approached well-being as a binary of "safe" or "unsafe"; and 4) mothers recognized that clinicians are obligated to report child abuse or neglect and recommended transparent CPS reporting.
CONCLUSIONS: Participants viewed child well-being in the setting of parental substance use as a multidimensional construct. Mothers acknowledged the potential emotional harms of substance use, an important target for family-based intervention. Mothers used harm reduction strategies to keep their children safe, but not all were aware that naloxone could be used to reverse pediatric overdoses. Improved provider guidance on comprehensively assessing child well-being, supporting harm reduction, and trauma-informed CPS reporting may help clinicians partner with families to support child health and safety.