Helping Children Exposed to Substance Abuse, Mental Illness, and Violence
By Beryl Lieff Benderly
Renee, now a married mother of two young daughters, was 8 years
old when she was sexually molested by an adult. "I didn't
know that I could tell anyone," she said. "I thought I would get
The abuse continued. In addition to this trauma, Renee later also
experienced substance abuse and mental problems.
Then last year, a boy at school inappropriately touched Renee's
daughter, Jennifer, in second grade at the time. Like Renee before
her, Jennifer "didn't really think she had a voice" to object, Renee
said. But now, thanks to an innovative intervention, Jennifer "knows
she has a choice" about whether and how people touch her, according
to Renee. "She sets boundaries for herself." Renee believes that
Jennifer, armed with this vital knowledge, now stands a good chance
of avoiding problems that marred her mother's life.
Back to Top
Jennifer learned this essential lesson in a facilitated children's
group funded by SAMHSA's Cooperative Agreement to Study Children
of Women with Alcohol, Drug Abuse, and Mental Health Disorders Who
Have Histories of Violence—known as the Children's Subset
Study for short. The study seeks to identify models of care for
the field that will prevent or reduce the intergenerational perpetuation
of violence, substance abuse, and mental illnesses, and reduce the
impact of violence in the lives of children whose mothers have co-occurring
mental and addictive disorders and histories of trauma.
The study participants are the children of women enrolled in SAMHSA's
ongoing Women, Co-Occurring Disorders, and Violence study, begun
in 1998 to test interventions to help women who have experienced
trauma and who have both substance abuse and mental illnesses. In
2000, 2 years into the study, SAMHSA launched the substudy aimed
at finding ways to help the children of these women strengthen their
ability to cope with experiences that threaten their safety and
Four of the participating women's sites—in Massachusetts,
Colorado, and one each in northern and southern California—were
chosen to participate in the Children's Subset Study.
All three SAMHSA Centers are participating in the study, which
is funded by SAMHSA's Center for Substance Abuse Treatment (CSAT).
"We continue to see how this study provides the medium to learn
about safety for children, the role of protective factors and resiliency,
and the importance of teaching children alternatives to violence,"
said Melissa Rael, R.N., M.P.A., CSAT senior program management
No previous research has systematically examined the combined
effects on children exposed to all three risk factors, according
to Jeanette Bevett-Mills, M.Ed., M.S., a public health advisor at
SAMHSA's Center for Substance Abuse Prevention.
However, she said, "Past experience suggests that they are at
high risk for substance abuse," highlighting the need to "break
the intergenerational cycle" of substance abuse within affected
families. "Because early experiences are crucial to development
throughout the life cycle," she said, finding ways to help vulnerable
children develop constructive ways to avoid substance abuse later
in life appears to be a promising strategy.
Family histories of substance abuse, mental illnesses, and exposure
to trauma may place children at risk for a range of mental health
problems, according to Kana Enomoto, public health analyst in SAMHSA's
Center for Mental Health Services. Although some of the study children
receive individual counseling or psychotherapy, the study hypothesizes
that group work among peers facing similar problems "can help in
ways that individual interventions cannot," Ms. Enomoto said. Knowing
that others also face these issues may help children develop greater
understanding and effective coping strategies "in ways they cannot
do alone," she added.
Back to Top
Jennifer attended group sessions in her hometown of Fall River,
MA, at Stanley Street Treatment and Resources (SSTAR), one of two
agencies in different parts of the state that are participating
as a single study site. Called the Women Embracing Life and Living
(WELL) Child Study, the project is supervised from offices in Cambridge
by principal investigator Norma Finkelstein, Ph.D. The project will
compare results from intervention sites where 30 children receive
several specially designed services to those from a comparison site
where 30 children receive what she calls "services as usual." Interviews
with mothers or caretakers conducted every 3 months will provide
As participants enter the women's study through agency referrals,
they are informed of the children's project and offered the opportunity
to enroll their children.
Some mothers, however, refuse permission, though "they want obviously
what's best for their kids," said Karen Gould, LICSW, project director
of the WELL Child study. "They might say, 'This is wonderful.'
But when a group starts, they say 'maybe this isn't such a
good time.' " Perhaps they do not trust the agency, she suggested,
or maybe they are "nervous about the fact that their child would
hear things . . . that maybe no one had ever really talked about."
Some may fear that their children will divulge sensitive family
Some, Dr. Finkelstein said, simply need "a little more sobriety,
more recovery [before] they can focus on their children because
they are mostly focused on themselves."
For mothers who do enter their children in the study, a clinical
assessment of both parent and child comes next.
"By the time I meet the women for assessment," Ms. Gould said,
"they know exactly what they're getting into and . . . they're very
motivated. What they'll say is 'This is exactly what my child
Back to Top
Back to Graphic Version