Current Projects

This NIDA-funded project is allowing us to tailor an implementation strategy bundle aimed at improving delivery of evidence-based parenting support for a peer recovery support specialist audience. The multilevel implementation bundle includes training, consultation, and implementation blueprint mapping to help overcome barriers to the delivery of parenting support. Building upon a longstanding community-academic partnership, we are collaborating with the Massachusetts Department of Public Health (MDPH) and their specialized home visiting program FIRST Steps Together (FST) to test this model.

This NIDA-funded hybrid effectiveness implementation trial will close the ‘science-to-service gap’ by: (a) testing the effectiveness of MIO among women in outpatient addiction treatment under ‘real-world’ conditions, (b) further elucidating the MIO mechanisms of change associated with improvements in caregiver behavior and maternal mental health outcomes, and (c) assessing key implementation constructs to support optimal uptake and treatment in future dissemination studies.

Parents access support from a variety of helpers in a variety of systems, and do not always receive direct support from mental health therapists. It is critical that the workforce thus employs reflective practices that support both parental reflection and within-team reflection. By adapting principles of MIO in addition to Dr. Arietta Slade’s Relational Foundations of Reflection and the Anna Freud Centre’s AMBIT approach, we are developing and testing a training curriculum for non-therapists.

The principles of MIO, namely the therapeutic relationship and the use of a reflective stance, are valuable tools for both therapists and non-therapists. In order to improve parent-provider relationships and trust in the healthcare team, doulas are being trained in the principles of MIO and trauma-informed care via a PCORI-funded project.

The Connecting and Reflecting Experience (CARE) is a group adaptation of MIO. It has been delivered virtually throughout the COVID-19 pandemic, and its efficacy is currently being studied in parents who are healthcare workers, as well as other highly stressed caregivers.

MIO is being adapted for implementation in the home visiting setting (e.g., Early Intervention, FIRST Steps Together) We are examining whether delivering MIO via early intervention developmental services improves postpartum outcomes for mothers in recovery from substance use disorders.

Although MIO is grounded in evidence that the maternal brain responds to infant cues differently in the context of addiction, it has yet to be examined whether intervention improves these differences. The NeMO (Neuroplasticity of Maternal OUD) study is thus examining whether MIO leads to changes in the way the maternal brain responds to infant signals (i.e., faces and cries)

Clinicians have noticed that beginning trauma-focused dyadic treatment with caregivers in recovery from substance use disorders can be challenging. Clinicians at the Health Federation of Philadelphia and researchers at Children’s Hospital of Philadephia (CHOP) are thus examining whether completing MIO prior to Child Parent Psychotherapy improves outcomes for these families.

Three clinical trials have been completed in the substance use treatment setting. Following a stage model of clinical intervention research, MIO has been examined in pilot, research-clinic efficacy, and community-based efficacy randomized controlled trials in collaboration with outpatient substance use treatment clinics, including the APT Foundation.

Although originally developed for mothers in substance use treatment, we recognized that the principles of MIO apply to many other groups, including mothers in outpatient mental health treatment. Findings suggested that MIO was feasible and acceptable when delivered in the community-based outpatient mental health setting and that all maternal indices improved.

The feasibility and acceptability of adapting Mothering from the Inside Out was tested in the Western Cape of South Africa. The collaborative process was guided by principles of community-based participatory research and examined themes in the feasibility and acceptability of the intervention. Qualitative and quantitative findings indicated preliminary promise, and several barriers and facilitators were documented.