SET-Enhanced Aftercare for Mothers in Substance Abuse Recovery and Their Childre

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The proposed study will conduct a translational randomized trial comparing Structural Ecosystems Therapy (SET) as an enhancement of substance abuse aftercare treatment, to aftercare treatment as usual (TAU) among 172 Black, Hispanic and White non-Hispanic mothers discharged from residential substance abuse treatment. The study will be conducted with a community partner that delivers integrated substance abuse treatment and primary care. Agency staff will conduct data collection and agency nurse practitioners will deliver SET. Data will be collected at baseline and 4, 8, and 12 month post-randomization. The Specific Aims of the proposed study are to: 1) test the effectiveness of SET for improving physical and mental health and reducing relapse of mothers in substance abuse recovery; 2) test the effectiveness of SET for improving health and mental health outcomes of children of mothers in recovery; 3) test mechanisms of action of SET (self care, environmental risk, family functioning and stigma); 4) assess SET implementation and sustainability factors and the relationship between fidelity and outcomes; and 5) examine the interactions of ethnicity and ethnicity-related factors on outcomes. SET is a manualized, strength-based, directive and process-oriented family-ecosystemic intervention developed to address the needs of minority women. SET targets the woman's social environment by building on existing adaptive interactions and reducing maladaptive interactions within the family and between the woman, family and supportive resources. A recently completed randomized trial with minority women in drug recovery who were also HIV+ found that for women who were raising children, SET resulted in reduced relapse and psychological distress in the mothers, and reduced symptoms of depression, anxiety and behavioral problems in the children. The proposed study will aim to demonstrate SET'S effectiveness, acceptability and feasibility for implementation in a community setting. The partnership between El Centro and Banyan Health Systems, a substance abuse and primary care provider with considerable research experience, provides a unique opportunity to rigorously test substance abuse aftercare treatment enhanced by SET in a real-world setting.