Treating Maternal PTSD to Enhance Parenting and Reduce Maltreatment Recidivism: Safe Mothers, Safe Children

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Project Summary Repeated exposure to abuse and neglect substantially increases the likelihood of poor child and adult life outcomes. Current child welfare (CW) family preservation services (FPS), however, do not reduce maltreatment recidivism. Maternal posttraumatic stress disorder (PTSD), which has been associated with poor parent-child interaction, is a promising intervention target to reduce maltreatment. Our prior work showed that mothers receiving FPS to prevent recidivism have a high prevalence of trauma-related disorders. High rates of PTSD among these mothers suggests that treating PTSD may reduce recidivism in a significant subset of high- risk mothers. In addition to directly increasing risk of maltreatment, PTSD-related cognitive deficits may make learning parenting skills more difficult, contributing to intergenerational persistence of trauma. Hypothesis: Parenting Skills Training in Affect and Interpersonal Regulation (P-STAIR), an intervention targeting maternal PTSD-related parenting deficits, will reduce recidivism. We use a combination of STAIR to target the adverse effects of PTSD (and related depression) on parenting and an abbreviated version of PCIT to improve parenting skills. STAIR is a two-phase treatment to improve emotion regulation and interpersonal skills prior to exposure treatment. It is more effective than exposure therapy alone and increases treatment retention for child abuse-related PTSD. PCIT is a dyadic treatment that has promise for reducing recidivism in CW mothers. We added a focus on how PTSD symptoms affect parenting and parent-child interaction skills: P-STAIR. Preliminary Data: Following P-STAIR, mothers had a 7-fold lower rate of new confirmed maltreatment reports (2.7%) than NYC’s FPS population as a whole (18.6%). Maternal PTSD and depression symptoms, measured at 90-day follow-up, show that 92.3% of mothers no longer met diagnostic criteria for PTSD. Independent behavioral observations demonstrated significant reduction of negative parenting behaviors and increased positive parenting behaviors. The pilot data indicate P-STAIR is feasible. We propose to conduct a RCT to evaluate efficacy of P-STAIR compared to supportive counseling (SC). Aim 1: Compare P-STAIR to SC with respect to maternal PTSD/depression symptom reduction. Aim 2: Compare P-STAIR to SC with respect to parenting behaviors. Aim 3: Compare P-STAIR to SC with respect to maltreatment recidivism. Impact: If demonstrated efficacious, P-STAIR will reduce maltreatment recidivism among high-risk CW involved mothers, ameliorating lives of children and families and reducing maternal stigma. Our CW partners’ support letters indicate P-STAIR has potential for ready CW dissemination, thereby altering real-world clinical practice.