Exploring Perceptions of Family Functioning and the Role of Psychosocial Support and Social Determinants of Health in Treatment Retention Among Recovering Parents with Opioid Use Disorder
Project Lead: Dr. Doris Titus Glover
Background
Lack of appropriate psychosocial and instrumental capital support for individuals in recovery from opioid use disorder (OUD) impacts family functioning. Addressing this need is imperative, as between half and three quarters of adults in substance use programs are parents. While interventions for OUD often focus on screenings, initiating pharmacotherapy, and symptom management, few studies address the role of parental psychosocial factors and the multiple stressors that increase the risks for reoccurrence. Though most research on parenting and recovery has focused on women, this study also integrated men, whose engagement is important in supporting families impacted by OUD. Without optimum recovery capital support to improve treatment retention, the challenges of recovery for parents can be insurmountable. The current research thus focuses on personal recovery capital, defined here as social determinants of health (SDOH), family functioning, and psychosocial support.
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Therefore, the purpose of this study was to explore recovery-oriented factors and to assess the role of family functioning, psychosocial support, and social determinants of health in treatment retention among parenting men and women with OUD. The project was conducted as a community-academic partnership between the University of Maryland School of Nursing and a local community partner with “boots-on-the-ground expertise.” This mutually beneficial research collaboration served to enhance the lives of parenting families with opioid use histories, built research capacity for the community-based recovery organization, and improved the resulting scientific inquiry through the practice knowledge brought by this partner.
Methods
This exploratory study used a mixed methods design and community-based participatory research (CBPR) approach. Quantitative surveys were utilized to measure various components of participants’ personal recovery capital, and these results will be examined to test for relationships with sustained recovery. Qualitative focus group interviews explored participants’ perceptions of psychosocial support, SDOH, family functioning, and their relationship to recovery and retention. A purposive sample of 63 men and women who are parents with OUD was drawn from the core community partner, as well as other recovery organizations. Demographic data was collected, and the following scales were administered: Multidimensional Scale of Perceived Social Support (MSPSS); Parenting Stress Index- Short Form (PSI-4); Accountable Health Communities Health-Related Social Needs Screening Tool (AHCHRSN); and Recovery Capital Scale (ARC). Sustained recovery was defined by participants’ retention in treatment for at least six months. Descriptive statistics were used to measure demographic data, and multivariate linear regression was used to test for associations between recovery support and sustained recovery. There were three focus groups conducted, with a total of 15 participants, using a semi-structured group interview format. This data was analyzed using inductive grounded theory, coding for thematic patterns using a phenomenological approach. Within the community-academic partnership, CBPR principles and practices grounded the research team, with relationship building, mutual respect, and bidirectional learning all prioritized.
Results
Data analysis is in process for this project, however, there are many important results to report regarding the study’s community-academic partnership and CBPR approach. This collaboration was developed through a commitment to strong inter-organizational and interpersonal relationships, creating a foundation for cooperation on this and future projects. Mutual interest in partnering was developed by sharing experiences, challenges, solutions, and future organizational and individual goals. To increase academic credibility and visibility, university partners hired research assistants referred from the community. Prior to designing a methodology, academics met with the agency partner to better understand community needs and conducted a neighborhood windshield survey to guide understanding of underlying environmental and systemic factors. Together research questions were identified, the project title was revised, final study objectives were formed, and the focus group interview format was determined to be best suited for this community. Through this approach, the study achieved a key goal of the research partners – to build capacity and a cadre of research skills for continued research collaboration in the community. This increased capacity was indicated by the confidence and skills built by research assistants, which grew as they moved through research training milestones. They gained self-sufficiency to lead the way in retooling data collection tools, recommending appropriate messaging for study promotion, engaging participants, and giving voice to community concerns and strengths. Ongoing weekly meetings, progress updates, and an open communication strategy were all utilized to help the team continually learn to further embody the tenets of community-engaged research.
Discussion
Mutual collaborations between researchers and community providers are necessary to identify and address challenges to sustaining recovery among parenting men and women with OUD. Study results, from pending data analysis as well as the above lessons learned regarding community-academic partnerships, may facilitate further community-engaged research and foster the adoption of effective strategies for sustaining recovery among this population.