A Qualitative Framework of Cumulative Risk and Protection for Understanding Neurodevelopment and Clinical Progress: A Multiple Case Study Approach

ABSTRACT

Prenatal substance exposure is a serious public health concern given that such exposure is associated with deficits across various neurodevelopmental domains. Mothercraft’s Breaking the Cycle (BTC) is a child maltreatment prevention and early intervention program in Canada for pregnant and parenting women who use substances and their children (0–6 years). Case studies of three substance-exposed sibling groups that received services at BTC are described to depict the spectrum of clinical progress that can be observed. The purpose of this study was to use our clinically and theoretically grounded, cross-domain cumulative risk and protection framework, previously developed for quantitative analyses, to qualitatively describe cumulative risk and protection. Using this framework within a qualitative case study approach yields insights into how contexts of risk and protection contribute to clinical progress. This study offers direction for future research to enhance understanding of the spectrum of clinical progress in substance-exposed families accessing early intervention. We discuss the clinical utility of this qualitative framework for case formulation and treatment planning. Understanding the balance between contexts of risk and protection qualitatively, and the link with neurodevelopment and clinical progress, can inform evidence-based, multisystemic early interventions that target key risk factors and promote salient protective factors.

KEYWORDS:

• Multiple case studies
• substance exposure
• cumulative risk
• cumulative protection
• clinical progress
• cross-domain
• child maltreatment

Authorship statement

All authors contributed to the study conception and design. Material preparation, data collection and analyses were performed by Bianca Bondi. The first draft of the manuscript was written by Bianca Bondi and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all mothers who were included in the study and mothers consented on behalf of their young children.

Disclosure statement

No conflicts of interest to report.

Supplementary materials

Supplementary data for this article can be accessed on the publisher’s website.

Additional information

Funding

This work was supported by the Canadian Institutes of Health Research [grant number 77757] and the Lillian Meighen and Don Wright Foundation.