Engagement in Early Intervention Services Among Mothers in Recovery From Opioid Use Disorders

Pediatrics. 2020 Feb;145(2):e20191957. doi: 10.1542/peds.2019-1957.


Background and objectives: Opioid-exposed infants frequently qualify for early intervention (EI). However, many eligible families choose not to enroll in this voluntary service. This study aims to understand the perceptions and experiences that may impact engagement with, and the potential benefits of, EI services among mothers in recovery from opioid use disorders (OUDs).

Methods: We conducted semistructured qualitative interviews (n = 22) and 1 focus group (n = 6) with mothers in recovery from OUDs in western Massachusetts. Transcripts were coded and analyzed by using a descriptive approach.

Results: The mean participant age was 32 years, and 13 had a high school degree or less. Five major themes emerged revealing mothers' development through stages of engagement in EI services: (1) fear, guilt, and shame related to drug use (emotions acting as barriers to enrollment); (2) the question of whether it is "needed" (deciding whether there is value in EI for opioid-exposed infants); (3) starting with "judgment" (baseline level of perceived stigma that parents in recovery associate with EI); (4) breaking down the "wall" (how parents overcome the fear and perceived judgment to build partnerships with providers); and (5) "above and beyond" (need for a personal connection with mothers and concrete supports through EI in addition to the child-focused services provided).

Conclusions: Barriers to engagement in EI among mothers in recovery from OUDs include a range of emotions, perceived stigma, and ambivalence. An effort to purposefully listen to and care for mothers through a strengths-based, bigenerational approach may help establish greater connections and foster stronger EI engagement among families affected by OUDs.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Early Medical Intervention*
  • Fear
  • Female
  • Focus Groups / statistics & numerical data
  • Guilt
  • Health Services Accessibility*
  • Humans
  • Infant
  • Infant, Newborn
  • Judgment
  • Massachusetts
  • Middle Aged
  • Mothers / psychology*
  • Neonatal Abstinence Syndrome / psychology
  • Neonatal Abstinence Syndrome / rehabilitation*
  • Opioid-Related Disorders / psychology*
  • Opioid-Related Disorders / rehabilitation
  • Professional-Patient Relations
  • Qualitative Research
  • Shame
  • Social Stigma
  • Young Adult