Substance‐abusing mothers in residential treatment with their babies: Importance of pre‐ and postnatal maternal reflective functioning

Pajulo, Marjukka; Pyykkönen, Nina; Kalland, Mirjam; Sinkkonen, Jari; Helenius, Hans; Punamäki, Raija‐Leena; Suchman, Nancy

doi:10.1002/imhj.20342

Cited by 155Maternal Mental Health During Pregnancy and PostpartumChild Welfare and AdoptionPsychoanalysis and Psychopathology Research

Substance‐abusing mothers in residential treatment with their babies: Importance of pre‐ and postnatal maternal reflective functioning

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Pajulo, Marjukka, Pyykkönen, Nina, Kalland, Mirjam, Sinkkonen, Jari, Helenius, Hans, Punamäki, Raija‐Leena, Suchman, Nancy·2012·Infant Mental Health Journal

DOI 10.1002/imhj.20342PMC PMC3418818

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Abstract

A residential treatment program has been developed specifically for substance-abusing pregnant and parenting women in Finland, focusing on simultaneously supporting maternal abstinence from substances and the mother-baby relationship. The aims of the study are to explore maternal pre- and postnatal reflective functioning and its association with background factors, maternal exposure to trauma, and psychiatric symptoms, postnatal interaction, child development, and later child foster care placement. Participants were 34 mother-baby pairs living in three residential program units during the pre- to postnatal period. We employed self-report questionnaires on background, trauma history, and psychiatric symptoms (Brief Symptom Inventory: L.R. Derogatis, 1993; Edinburgh Postnatal Depression Scale: J.L. Cox, J.M. Holden, & R. Sagovsky, 1987; Traumatic Antecedents Questionnaire: B. Van der Kolk, 2003), videotaped mother-child interactions coded for sensitivity, control, and unresponsiveness (Care Index for Infants and Toddlers: P. Crittenden, 2003); a standardized test of child development (Bayley Scales of Infant Development-II: N. Bayley, 1993); and semistructured interviews for maternal reflective functioning (Pregnancy Interview: A. Slade, E. Bernbach, J. Grienenberger, D.W. Levy, & A. Locker, 2002; Parent Development Interview: A. Slade et al., 2005). Pre- and postnatal maternal reflective functioning (RF) was on average low, but varied considerably across participants. Average RF increased significantly during the intervention. Increase in RF level was found to be associated with type of abused substance and maternal trauma history. Mothers who showed lower postnatal RF levels relapsed to substance use more often after completing a residential treatment period, and their children were more likely to be placed in foster care. The intensive focus on maternal RF is an important direction in the development of efficacious treatment for this very high risk population.

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Mothers who abused alcohol and who reported more severe post-traumatic experiences showed a lower increase of RF.
“Mothers who abused alcohol and who reported more severe post-traumatic experiences showed a lower increase of RF.”
From Mentalizing makes parenting work: a review about parental reflective functioning and clinical interventions to improve it (2017) · cites this paper as Pajulo et al., 2012
Mothers whose children were later placed into foster care had lower RF, both during pregnancy and in the post-natal phase.
“Furthermore, mothers whose children were later placed into foster care had lower RF, both during pregnancy and in the post-natal phase.”
From Mentalizing makes parenting work: a review about parental reflective functioning and clinical interventions to improve it (2017) · cites this paper as Pajulo et al., 2012
The major limitation of Pajulo et al. (2012) was not having used a randomized controlled design.
“The major limitation of this study was not having used a randomized controlled design, which was instead used in the following studies we reviewed.”
From Mentalizing makes parenting work: a review about parental reflective functioning and clinical interventions to improve it (2017) · cites this paper as Pajulo et al., 2012
Pajulo et al. (2012) reported that RF levels increased from pregnancy (measured through PI-RF) to the post-natal phase (assessed by PDI-RF) in the majority (63%) of mothers who received the treatment.
“A recent outcome study (Pajulo et al., 2012) reported that RF levels increased from pregnancy (measured through PI-RF) to the post-natal phase (assessed by PDI-RF) in the majority (63%) of mothers who received the treatment.”
From Mentalizing makes parenting work: a review about parental reflective functioning and clinical interventions to improve it (2017) · cites this paper as Pajulo et al., 2012

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Substance abusing mothers in residential treatment with their babies: Postnatal psychiatric symptomatology and its association with mother–child relationship and later need for child protection actions
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Prenatal Reflective Functioning as a Predictor of Substance-Using Mothers' Treatment Outcome: Comparing Results From Two Different RF Measures
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Reflective functioning in mothers with addictions: Differential relationships involving family history of mental illness and substance use
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Authors: Pajulo, M., Pyykkönen, N., Kalland, M., Sinkkonen, J., Helenius, H., Punamäki, R., & Suchman, N.
Affiliations: University of Turku (FI)
University of Helsinki (FI)
Yale University (US)
Corresponding author: Pajulo, Marjukka
ORCID: Pajulo, Marjukka
Kalland, Mirjam
Punamäki, Raija‐Leena
Suchman, Nancy
Venue: Infant Mental Health Journal
Publisher: Wiley
Published: 2012-01
Volume: 33
Issue: 1
Pages: 70-81
ISSN: 0163-9641 (ISSN-L)
1097-0355
DOI: 10.1002/imhj.20342
PMC: PMC3418818
OpenAlex: W2113595872
Cited by: 155
References: 40
Citations by year: 2026: 4 · 2025: 9 · 2024: 10 · 2023: 13 · 2022: 9 · 2021: 17 · 2020: 12 · 2019: 15 · 2018: 10 · 2017: 16 · 2016: 10 · 2015: 13 · 2014: 9 · 2013: 6 · 2012: 2
FWCI: 9.26
Type: journal article
Language: en
Open access: green
europepmc.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor, 22 d)
Locations: Infant Mental Health Journal (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute on Drug Abuse (R01DA017294, K02DA023504)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
Social Sciences › Safety Research › Child Welfare and Adoption
Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords: maternal reflective functioning, substance abuse in pregnancy, residential treatment, mother-infant relationship, postpartum depression, mother-child interaction, child development, foster care placement, prenatal drug exposure

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Substance‐abusing mothers in residential treatment with their babies: Importance of pre‐ and postnatal maternal reflective functioning

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