***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A women 's therapeutic community ( TC ) design ed to prevent homelessness was evaluated using a quasi-experimental process . Propensity analysis selected comparable experimental ( E ) and comparison ( C ) participants . Significant improvements were found for the E group at the domain level , both in “ psychological ” dysfunction on symptoms ( e.g. , depression ) , and in “ health , ” including ratings of health and adherence to medication regimens . No significant difference was found at the domain level for “ parenting ” or “ housing stabilization , ” but specific outcomes did differ . For example , a greater number of children resided with the E  group mothers who also assumed financial responsibility for more of their children AIMS To assess the quality of r and omized controlled trials ( RCTs ) published in Neurourology and Urodynamics ( NAU ) by using three types of analytical tools . METHODS MEDLINE was used to extract RCTs from original articles published in the NAU from 1993 to 2012 . The relationship between the number of articles and RCTs with time and that between various factors and the quality of RCTs were analyzed . To analyze the quality of the RCTs , the time period was divided into four sections and three tools were applied ( e.g. , the Jadad scale , van Tulder scale , and Cochrane Collaboration Risk of Bias Tool [ CCRBT ] ) . RESULTS Among the 1,957 original articles , 93 ( 4.75 % ) were RCTs . The ratio between the number of NAU and RCTs over time increased . The Jadad score for years 1993 - 1997 was 3.25 ± 1.71 , 1998 - 2002 was 2.10 ± 0.74 , 2003 - 2007 was 2.09 ± 1.12 , and 2008 - 2012 was 2.80 ± 1.09 ( P = 0.014 ) . The van Tulder scales were 6.25 ± 3.10 , 4.40 ± 1.65 , 4.97 ± 1.99 , and 5.93 ± 1.98 , respectively ( P = 0.055 ) . The CCRBT identified a low risk of bias in 1 ( 25 % ) , 0 ( 0 % ) , 1 ( 2.86 % ) , and 5 ( 11.36 % ) articles , respectively . Trials with allocation concealment , Institutional review board ( IRB ) approval , and blinded studies had significantly higher quality than others . CONCLUSIONS The quantitative increase of RCT presented in NAU over time was observed but there was no definite qualitative improvement . Effort is required to improve the quality of RCTs published in NAU from the design step Previously , we reported posttreatment findings from a r and omized pilot study testing a new attachment-based parenting intervention for mothers enrolled in substance-use treatment and caring for children ages birth to 3 years ( N.E. Suchman , C. DeCoste , N. Castiglioni , T. McMahon , B. Rounsaville , & L. Mayes , 2010 ) . The Mothers and Toddlers Program ( MTP ) is a 12-session , weekly individual parenting therapy that aims to enhance maternal capacity for reflective functioning and soften harsh and distorted mental representations of parenting . In a r and omized pilot study , 47 mothers who were enrolled in outpatient substance-abuse treatment and caring for children between birth and 3 years of age were r and omized to the MTP versus the Parent Education Program ( PE ) , a comparison intervention that provided individual case management and developmental guidance . At the end of treatment , mothers in the MTP condition demonstrated better reflective functioning , representation quality , and caregiving behavior than did mothers in the PE condition . In this investigation , we examined whether the benefits of MTP at posttreatment were sustained at the 6-week follow-up . Recently , we also identified two components of parental reflective functioning : ( a ) a self-focused component representing the parent 's capacity to mentalize about strong personal emotions ( e.g. , anger , guilt , or pain ) and their impact on the child and ( b ) a child-focused component representing the parent 's capacity to mentalize about the child 's emotions and their impact on the mother ( N. Suchman , C. DeCoste , D. Leigh , & J. Borelli , 2010 ) . In this study , we reexamined posttreatment outcomes using these two related , but distinct , constructs High rates of child abuse and neglect occur in many families in which either or both parents abuse illicit drugs . This study reports on the results of a r and omized controlled trial with families having a parent on methadone maintenance ( N = 64 ) , in which an intensive , home-based intervention , the Parents Under Pressure ( PUP ) program , was compared to st and ard care . A second brief intervention control group of families received a two-session parenting education intervention . The PUP intervention draws from the ecological model of child development by targeting multiple domains of family functioning including the psychological functioning of individuals in the family , parent-child relationships , and social context ual factors . Mindfulness skills were included to address parental affect regulation , a significant problem for this group of parents . At 3- and 6-month follow-up , PUP families showed significant reductions in problems across multiple domains of family functioning , including a reduction in child abuse potential , rigid parenting attitudes , and child behavior problems . Families in the brief intervention group showed a modest reduction in child abuse potential but no other changes in family function . There were no improvements found in the st and ard care group and some significant worsening was observed . Results are discussed in terms of their implication s for improved treatment OBJECTIVE This study evaluated lifetime traumatic events and current posttraumatic stress disorder ( PTSD ) symptoms in a substance abuse sample . METHOD Participants in the study consisted of 558 ( 75.1 % male ) cocaine-dependent individuals who completed self-report measures of trauma and PTSD symptoms prior to entry into treatment .  RESULTS Results showed a high number of lifetime traumatic events , even among those without PTSD . General disaster was the most prevalent . Current PTSD was found in 10.9 % of the participants , with a significantly higher rate among women ( 21.6 % ) than among men ( 7.2 % ) . For those with PTSD , the most prominent PTSD symptom cluster was arousal , and the most common symptoms were restricted affect , detachment and irritability . Participants with PTSD endorsed a large number of symptoms , almost double that needed to meet diagnostic criteria ; however , neither number of traumas nor type of trauma was associated with their level of PTSD symptoms . Even among those not meeting PTSD criteria , subthreshold symptoms were found , with avoidance the most prominent cluster . Sociodemographic and recent cocaine use variables did not differentiate the PTSD from non-PTSD groups . CONCLUSIONS PTSD is present in a sizeable percentage of cocaine-dependent treatment-seeking patients , particularly women . Clinicians might address arousal symptoms in particular , which were the most prominent symptom cluster , and which may be exacerbated by cocaine use . Even among those without PTSD , lifetime trauma is substantial and subthreshold PTSD symptoms are common . Vulnerability to PTSD needs further study , as sociodemographic and cocaine use variables did not distinguish between PTSD and non-PTSD groups This is a report of post-treatment findings from a completed r and omized pilot study testing the preliminary efficacy of the Mothers and Toddlers Program ( MTP ) , a 12 week attachment-based individual parenting therapy for mothers enrolled in substance abuse treatment and caring for children ages birth to 36 months . Forty-seven mothers were r and omized to MTP versus the Parent Education Program ( PE ) , a comparison intervention providing individual case management and child guidance brochures . At post-treatment , MTP mothers demonstrated better reflective functioning in the Parent Development Interview , representational coherence and sensitivity , and caregiving behavior than PE mothers . Partial support was also found for proposed mechanisms of change in the MTP model . Together , preliminary findings suggest that attachment-based interventions may be more effective than traditional parent training for enhancing relationships between substance using women and their young children To examine the impact of integrated treatment programs ( those with substance use treatment and pregnancy- , parenting- , or child-related services ) on  maternal mental health  , we compiled a data base of studies of  integrated programs published between 1990 and 2007 with outcome data on maternal mental health . There were 18 cohort studies , 3 r and omized trials , and 2 quasi-experimental studies . Of the five studies comparing integrated to nonintegrated programs , three studies provided enough information to allow for them to be combined in a meta- analysis . The average effect size was 0.23 ( 95 % CI = 0.15 to 0.31 , SE = 0.04 ) , p < .001 . There was no statistically significant heterogeneity among the studies , Q = 5.66 , p = .059 . This meta- analysis is the first systematic quantitative review of studies evaluating the impact of integrated programs on maternal mental health . Findings suggest that integrated programs may be associated with a small advantage over nonintegrated programs in improving maternal mental health . This review highlights the need for further research with improved methodology , study quality , and reporting to improve our underst and ing of how best to meet the mental health needs of mothers with substance abuse issues BACKGROUND Children of substance abusers are at risk for behavioral/emotional problems . To improve outcomes for these children , we developed and tested an intervention that integrated a novel contingency management ( CM ) program design ed to enhance compliance with an empirically-vali date d parent training curriculum . CM provided incentives for daily monitoring of parenting and child behavior , completion of home practice assignments , and session attendance . METHODS Forty-seven mothers with substance abuse or dependence were r and omly assigned to parent training+incentives ( PTI ) or parent training without incentives ( PT ) .  Children were 55 % male , ages 2 - 7 years . RESULTS Homework completion and session attendance did not differ between PTI and PT mothers , but PTI mothers had higher rates of daily monitoring . PTI children had larger reductions in child externalizing problems in all models . Complier Average Causal Effects ( CACE ) analyses showed additional significant effects of  PTI on child internalizing problems , parent problems and parenting . These effects were not significant in st and ard Intent-to-Treat analyses . CONCLUSION Results suggest our incentive program may offer a method for boosting outcomes In response to the need for effective drug court interventions , the effectiveness of the Engaging Moms Program ( EMP ) versus Intensive Case Management Services ( ICMS ) on multiple outcomes for mothers enrolled in family drug court was investigated . In this intent-to-treat study , mothers ( N = 62 ) were r and omly assigned to either usual drug court care or the Engaging Moms drug court program .  Mothers were assessed at intake and 3 , 6 , 12 , and 18 months following intake . Results indicated that at 18 months post drug court enrollment , 77 % of mothers assigned to EMP versus 55 % of mothers assigned to ICMS had positive child welfare dispositions . There were statistically significant time effects for both intervention groups on multiple outcomes including substance use , mental health , parenting practice s , and family functioning . EMP showed equal or better improvement than ICMS on all outcomes . The results suggest that EMP in family drug court is a viable and promising intervention approach to reduce maternal addiction and child maltreatment 
    Output:
    
In the three studies that examined factors associated with treatment effects , parenting improvements were associated with attachment-based parenting interventions , children residing in the treatment facility , and improvements in maternal mental health .
Conclusions This is the first systematic review of studies evaluating the effectiveness of integrated programs on parenting .
The limited available evidence supports integrated programs , as findings suggest that they are associated with improvements in parenting skills .