Edinburgh Napier University

  Aim
To test whether Behavioural Couples Therapy (BCT), a USA-developed evidence-based psychological therapy for the treatment of addiction, can be successfully delivered within NHS drug treatment services with drug-dependent parents who have children living in the home, and whether it is possible to collect outcome data on families for a future trial.
Project Outline/Methodology
Mixed methods feasibility study comprising staff training in BCT, recruitment of couples from NHS addiction services and delivery of the 12-week out-patient programme. Inclusion criteria: one or both parents receiving Opioid Substitution Therapy (OST), caring for at least one child aged 0-16 years. Data collection: standard measures on substance use, couple relationship functioning, parenting, child welfare, administered before commencing BCT and after completion/drop out. Drug toxicology and breathalyser results, OST prescription data, child protection Social Work Scotland records, health economic data and fidelity testing were also included. Qualitative data was generated through interviews with BCT couples (n=13), other drug-dependent parents (n=11); BCT therapists (n=6), and five focus groups with referrers (n=24). Analysis focused on uptake, attrition and completion rates, acceptability of BCT, and barriers/facilitators to implementation.
Key Results
Thirteen couples (out of a target 18), were enrolled in the study between June 2016–June 2017. Parents reported complex needs related to multiple co-morbidities. Only 7/13 couples engaged in the intervention following enrolment. None completed the programme. Session attendance for the cohort was 14%. Average number of sessions completed was 1.8 (3.4 by those who started the intervention). Barriers to implementation were multi-level and inter-related. They included patient, clinician, intervention, service, operational and structural-level obstacles to acceptability, suitability, engagement, retention, and delivery of BCT. Strategies which facilitated implementation, as well as potential solutions to implementation problems, were identified. Reported benefits of BCT mainly related to improvements in couple relationships and indirect benefits on the caregiving environment and child wellbeing.
Conclusions
Findings from this study suggest that a trial of BCT with this population is not feasible at this time. Barriers and facilitators to implementation need further consideration. Adapting the intervention and its mode of delivery may improve implementation. Adopting a proactive family-focused model of care in drug treatment services and closer joint working between adult and children’s services could lead to improved accessibility, engagement and retention.