This paper examines the relationship between the living arrangement of mother and baby in a residential treatment center and measures of selfesteem, depression and parenting sense of competence and a woman's length of stay and completion or non-completion of treatment. Scores on the Bayley Scales of Infant Development (Bayley 1969) are also examined by the amount of time the baby spent with mother, an arrangement that affords the opportunity for the child to participate in the facility's therapeutic child care center. Findings suggest that the earlier a mother's infant resides with her in the treatment setting, the longer her length of stay will be, with an increased opportunity for program completion. In addition, measures of depression were lower and measures of self-esteem were higher for women with their babies than for clients who did not have their infant in the treatment facility. Scores on the Bayley Scales of Infant Development were within normal limits for all infants living with their mothers in treatment.
Studies indicate that between 5% and 25% of pregnant women are using illegal drugs or harmful substances like alcohol and tobacco, often in combination, during part or all of their pregnancy. The Federal Center for Substance Abuse Prevention (CSAP) approximates that some 375,000 infants are born each year to women who used drugs or alcohol during their pregnancies (U.S. Department of Health and Human Services 1993). Many of these women are in need of treatment services.
Some of them will be overlooked by the prenatal health care system and not referred (Gehshan 1995); many others will seek treatment either voluntarily or be mandated into treatment through judicial or child protection systems. This situation presents challenges to the treatment delivery system and requires the development of programs that accommodate the special needs of women and their children (Finkelstein 1993b, Finnegan 1991) as well as services that enhance retention. In the last 10 years a modest number of programs around the country have been developed to provide services with a variety of therapeutic approaches for pregnant and postpartum women and their infants (Metsch et al. 1995; Schmidt and Weisner 1995; Stevens and Arbiter 1995).
Previous research has indicated that women will stay in the residential treatment setting longer if they are permitted to have their children with them (Hughes et al. 1995). However, delays in unification often occur. Women may or may not be allowed to keep their baby at birth; sometimes weeks or months pass before an infant is actually residing in the treatment setting with the mother. Reasons for this delay are difficult to determine but seem to be based on State or local policy decisions aimed at protection of the infants. The impact of these policies on maternal and infant bonding and maternal treatment success has not been well researched. The purpose of this paper is to examine issues surrounding maternal custody of infants and how this impacts the mother's success in treatment, as well as infant outcomes. This paper examines the relationship of the living arrangement of mother and baby in a residential treatment center to mother's length of stay, completion or noncompletion of treatment, and measures of self-esteem, depression and parenting sense of competence. Scores on the Bayley Scales of Infant Development (BSI) (Bayley, 1969) are also examined by the timing of custody for mother and infant. This is an approximation for the amount of time the baby has spent with the mother, an arrangement that includes an opportunity for the child to participate in the facility's therapeutic childcare center.
Treatment Issues for Pregnant and Post-Partum Women
Treatment modalities usually include levels of treatment such as detoxification, primary and intermediate rehabilitation, and options for inpatient or outpatient care (Farkas and Parran …